Provider Demographics
NPI:1053695544
Name:QUAGLIERI, JUDITH (RPH)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:QUAGLIERI
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 1:3855 S MOORLAND RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-5225
Mailing Address - Country:US
Mailing Address - Phone:262-784-4992
Mailing Address - Fax:
Practice Address - Street 1:3855 S MOORLAND RD
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-5225
Practice Address - Country:US
Practice Address - Phone:262-784-4992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10684-040183500000X
IL051-033871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist