Active NPI
Stephanie Lynn Poliquin
- Pharmacist
- Wauwatosa, WI
National Provider Identifier
1417581042
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19485
- Practice address
- 2275 N Mayfair Rd
Wauwatosa, WI 53226-2207 - Phone
- (414) 774-4821
- Fax
- (414) 774-3855
- NPI assigned
- Feb 22, 2020
- Last updated
- Feb 22, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 19485 | WI | Primary |
Addresses
Primary practice location
2275 N Mayfair Rd
Wauwatosa, WI 53226-2207
Mailing address
2275 N Mayfair Rd
Wauwatosa, WI 53226-2207
Phone (414) 774-4821
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19485 | WI | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
2275 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 456-1703
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582329600000",
"number": "1417581042",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2275 N MAYFAIR RD",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532262207",
"telephone_number": "414-774-4821",
"fax_number": "414-774-3855"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2275 N MAYFAIR RD",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532262207",
"telephone_number": "414-774-4821",
"fax_number": "414-774-3855"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLIQUIN",
"first_name": "STEPHANIE",
"middle_name": "LYNN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-02-22",
"last_updated": "2020-02-22",
"certification_date": "2020-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "19485",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wauwatosa, WI
- Plumeria Acupuncture and Holistic Wellness Center, LLC
- James Michael Podnar, DDS
- Jennifer Elizabeth Poe, MSW,LCSW
- Emily Pokorny, APNP
- Amanda Lyn Polachek
- Neal Howard Pollack, D.O.
- Debra Sue Pollesch, RN, IBCLC
- Russell Pope, M.S., LPC
- Monique NE'Sha Portwood, MA, LPC-IT
- Leah Arlene Pounds, LPC-IT, SAC-IT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.