Provider Demographics
NPI:1053526244
Name:WAEGE, TAIT DAVID (RPH)
Entity type:Individual
Prefix:MR
First Name:TAIT
Middle Name:DAVID
Last Name:WAEGE
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:N241 CTY HWY AB
Mailing Address - Street 2:
Mailing Address - City:DENMARK
Mailing Address - State:WI
Mailing Address - Zip Code:54208
Mailing Address - Country:US
Mailing Address - Phone:920-776-1109
Mailing Address - Fax:
Practice Address - Street 1:3310 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5426
Practice Address - Country:US
Practice Address - Phone:920-320-4400
Practice Address - Fax:920-320-4444
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13085-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist