Provider Demographics
NPI:1487976239
Name:PRACHT, DALE HENRY (RPH)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:HENRY
Last Name:PRACHT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 WEDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-1974
Mailing Address - Country:US
Mailing Address - Phone:715-831-8964
Mailing Address - Fax:
Practice Address - Street 1:2601 SOUTH MAIN ST
Practice Address - Street 2:KMART PHARMACY
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868
Practice Address - Country:US
Practice Address - Phone:715-234-3292
Practice Address - Fax:715-234-5764
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7785183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist