Provider Demographics
NPI:1538774286
Name:STINE, JOSHUA D (PHARMD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:D
Last Name:STINE
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 1:4411 EAGLE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:WI
Mailing Address - Zip Code:53598-2303
Mailing Address - Country:US
Mailing Address - Phone:262-844-5170
Mailing Address - Fax:
Practice Address - Street 1:302 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-9827
Practice Address - Country:US
Practice Address - Phone:608-837-5949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18356-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist