Healthcare Provider Details

I. General information

NPI: 1285528786
Provider Name (Legal Business Name): EMILY KULOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2025
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 CALUMET AVE
MANITOWOC WI
54220-5426
US

IV. Provider business mailing address

3300 CALUMET AVE
MANITOWOC WI
54220-5426
US

V. Phone/Fax

Practice location:
  • Phone: 920-682-3051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number22754-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: