Provider Demographics
NPI:1861778821
Name:SOEFKER, LOUIS JOHN JR (RPH)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:JOHN
Last Name:SOEFKER
Suffix:JR
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 1:1300 REDWING DR
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-2379
Mailing Address - Country:US
Mailing Address - Phone:262-567-4767
Mailing Address - Fax:
Practice Address - Street 1:1300 REDWING DR
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-2379
Practice Address - Country:US
Practice Address - Phone:262-567-4767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10135-40183500000X
IL051.031802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist