Provider Demographics
NPI:1174194930
Name:VOGEL, TAWNY LYNN
Entity type:Individual
Prefix:
First Name:TAWNY
Middle Name:LYNN
Last Name:VOGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 N MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53404-3270
Mailing Address - Country:US
Mailing Address - Phone:262-637-4900
Mailing Address - Fax:262-637-7148
Practice Address - Street 1:819 N MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53404-3270
Practice Address - Country:US
Practice Address - Phone:262-637-4900
Practice Address - Fax:262-637-7148
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20922-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty