Provider Demographics
NPI:1487082574
Name:BRONNICHE, CLIFFORD WILLIAM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:WILLIAM
Last Name:BRONNICHE
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 1:3705 TOWER AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-5338
Mailing Address - Country:US
Mailing Address - Phone:715-392-9520
Mailing Address - Fax:715-392-9521
Practice Address - Street 1:3705 TOWER AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5338
Practice Address - Country:US
Practice Address - Phone:715-392-9520
Practice Address - Fax:715-392-9521
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17056-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist