Provider Demographics
NPI:1427681014
Name:VOMHOF, NATHAN EDWARD (PHARM D)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:EDWARD
Last Name:VOMHOF
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 E CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1250
Mailing Address - Country:US
Mailing Address - Phone:414-964-9851
Mailing Address - Fax:414-964-0695
Practice Address - Street 1:370 E CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-1250
Practice Address - Country:US
Practice Address - Phone:414-964-9851
Practice Address - Fax:414-964-0695
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist