Provider Demographics
NPI:1386278281
Name:SEIDLITZ, ANDREW (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:SEIDLITZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10489 STATE ROAD 27
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-2000
Mailing Address - Country:US
Mailing Address - Phone:715-634-1919
Mailing Address - Fax:715-634-1925
Practice Address - Street 1:10489 STATE ROAD 27
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-2000
Practice Address - Country:US
Practice Address - Phone:715-634-1919
Practice Address - Fax:715-634-1925
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18517-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist