Provider Demographics
NPI:1053576041
Name:KATZFUSS, ANGELA N (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:N
Last Name:KATZFUSS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 HORICON ST
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53050-1429
Mailing Address - Country:US
Mailing Address - Phone:920-387-7800
Mailing Address - Fax:
Practice Address - Street 1:1028 HORICON ST
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:WI
Practice Address - Zip Code:53050-1429
Practice Address - Country:US
Practice Address - Phone:920-387-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-19
Last Update Date:2008-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14720-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33184600Medicaid