Provider Demographics
NPI:1669807079
Name:BABKA-GOLDSMITH, MARY L (RPH)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:BABKA-GOLDSMITH
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 1:1470 WEBB ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54829-9187
Mailing Address - Country:US
Mailing Address - Phone:715-822-2424
Mailing Address - Fax:
Practice Address - Street 1:1470 WEBB ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:WI
Practice Address - Zip Code:54829-9187
Practice Address - Country:US
Practice Address - Phone:715-822-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10444-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist