Provider Demographics
NPI:1306115431
Name:ROENITZ, CHRISTINE (RPH)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:ROENITZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 S BUSINESS DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-6528
Mailing Address - Country:US
Mailing Address - Phone:920-452-5858
Mailing Address - Fax:920-452-4968
Practice Address - Street 1:3320 S BUSINESS DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-6528
Practice Address - Country:US
Practice Address - Phone:920-452-5858
Practice Address - Fax:920-452-4968
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist