MS. TONYA JANELLE WILDERMAN (NPI# 1750622163) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750622163 |
| Entity Type | Individual |
| Full Name | MS. TONYA JANELLE WILDERMAN |
| Other Name | MR. TIMOTHY JON WILDERMAN |
| Credential | RPH |
| Practice Address |
1400 N Mccarthy Rd Apt 2 Grand Chute WI 54913 |
| Practice Telephone | 4143317531 |
| Practice Fax Number | 4144631112 |
| Mailing Telephone | 4143317531 |
| Enumeration Date | 2013-03-10 |
| Last Update Date | 2018-10-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 10979 | WI | Pharmacy Service Providers |
| Street Address |
1400 N MCCARTHY RD APT 2 |
| City | GRAND CHUTE |
| State | WI |
| Zip Code | 54913 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457994584 | Pamela J Andersen | Music Therapist | 245 N. Metro Drive, Appleton, WI 54913 | 2019-10-22 |
| 1396387510 | Nancy Sibley | Technician | N4423 County Road Ee, Appleton, WI 54913 | 2019-10-09 |
| 1659872240 | Meijer Stores Limited Partnership | Durable Medical Equipment & Medical Supplies | 3801 N. Richmond Street, Grand Chute, WI 54913 | 2018-02-28 |
| 1780116244 | Alison Pelger | Physician Assistant | 3916 North Intertech Court, Appleton, WI 54913 | 2017-04-03 |
| 1316311905 | Lucy Bouressa | Specialist/Technologist | 2105 E. Enterprise Ave, 113, Appleton, WI 54913 | 2015-11-19 |
| 1992189989 | Brittany Reinke | Physical Therapist | Walking and Wheeling, LLC, W4652 Glenn Street, Appleton, WI 54913 | 2015-07-20 |
| 1902280092 | Costco Wholesale Corporation | Pharmacy | 5401 W Integrity Way, Grand Chute, WI 54913 | 2015-07-17 |
| 1942646849 | Richard Anthony Mauthe | Pharmacist | 5401 W. Integrity Way, Neenah, WI 54913 | 2013-05-17 |
| 1295938777 | Jenna Marie Kadlec | Physical Therapist | 3916 N. Intertech Court, Appleton, WI 54913 | 2007-06-11 |
| 1275753659 | Apple Creek Oral Surgery, Sc | Dentist | 2410 East Evergreen Drive, Appleton, WI 54913 | 2007-04-26 |
| Find all providers in zip 54913 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215286752 | Jose M Carrasco | Pharmacist | 4016 Towne Lakes Cir, Apt #7212, Grand Chute, WI 54913-8006 | 2012-08-30 |
| 1760872287 | James Dreier | Pharmacist | 2400 W Wisconsin Ave, Grand Chute, WI 54914-3109 | 2015-02-04 |
| 1841576543 | Mark Gordon | Pharmacist | 1305 N Casaloma Dr, Grand Chute, WI 54913-8848 | 2011-10-25 |
| 1629354691 | Trisha Doell | Pharmacist | 1305 N Casaloma Dr, Grand Chute, WI 54913-8848 | 2011-10-22 |
| 1477833127 | Laura Jasperson | Pharmacist | 1305 N Casaloma Dr, Grand Chute, WI 54913-8848 | 2011-08-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578164349 | Lynn Huynh | Pharmacist | 5695 Washington Ave, Racine, WI 53406 | 2020-11-06 |
| 1346841822 | Tam Dinh | Pharmacist | 7480 Karth Ct, Franklin, WI 53132-8509 | 2020-11-02 |
| 1356940845 | Colette A. Probasco | Pharmacist | N1021 Blues Ln, Hortonville, WI 54944-9265 | 2020-10-26 |
| 1104425784 | Seang Foo | Pharmacist | 875 E Wisconsin Ave # Ms 2870, Milwaukee, WI 53202-5404 | 2020-10-23 |
| 1053910067 | Mary Ellen F Pumper | Pharmacist | 861 County Rd F, Berlin, WI 54923 | 2020-10-21 |
| 1609475607 | Suchart Thammahong | Pharmacist | 734 Mclean Drive, Madison, Wi, WI 53718 | 2020-10-21 |
| 1427657493 | Sarah R. Kozikowski | Pharmacist | 226100 Rib Mountain Dr, Wausau, WI 54401-3346 | 2020-10-21 |
| 1063011252 | Kelsey Eickstaedt | Pharmacist | 15594 State Hwy 77, Hayward, WI 54843 | 2020-10-20 |
| 1295334373 | James Michael Branning | Pharmacist | 226200 Rib Mountain Dr, Wausau, WI 54401-3347 | 2020-10-20 |
| 1174122576 | Paul Suiven Mbinglo | Pharmacist | 6237 94th Ct, Kenosha, WI 53142-8225 | 2020-10-19 |
| Find all providers with the same taxonomy | ||||
| City | GRAND CHUTE |
| Zip Code | 54913 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.