Provider Demographics
NPI:1699934802
Name:FERNHOLZ, PAUL KEVIN (RPH)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:KEVIN
Last Name:FERNHOLZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 2ND ST
Mailing Address - Street 2:P.O. BOX 245
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-1602
Mailing Address - Country:US
Mailing Address - Phone:608-524-3215
Mailing Address - Fax:608-524-8410
Practice Address - Street 1:115 2ND ST
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-1602
Practice Address - Country:US
Practice Address - Phone:608-524-3215
Practice Address - Fax:608-524-8410
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI94511835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist