Michael David Stubenvoll, PHARMD
Individual provider Active NPI Pharmacist · Sister Bay, WI
NPI 1043970304 · NPPES record last updated Dec 28, 2021
Key facts
- NPI
- 1043970304
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 21220-40 (WI)
- Practice address
- 10578 Country Walk Dr Unit 27
Sister Bay, WI 54234-9114 - Phone
- (920) 633-4060
- Fax
- (920) 633-4062
- NPI assigned
- Dec 28, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21220-40 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sister Bay Hometown Pharmacy LLC | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 21220-40 | WI | Yes |
Addresses
Primary practice location
10578 Country Walk Dr Unit 27
Sister Bay, WI 54234-9114
Mailing address
10578 Country Walk Dr Unit 27
Sister Bay, WI 54234-9114
Phone (920) 633-4060
Other providers in Sister Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 28, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.