Provider Demographics
NPI:1528789369
Name:KIZEWSKI, REBECCA J (RPH)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:KIZEWSKI
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 1:1307 N SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-1340
Mailing Address - Country:US
Mailing Address - Phone:715-221-8722
Mailing Address - Fax:
Practice Address - Street 1:1307 N SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-1340
Practice Address - Country:US
Practice Address - Phone:715-221-8722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11658-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist