Healthcare Provider Details

I. General information

NPI: 1760576755
Provider Name (Legal Business Name): PHARMASAN LABS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 280TH ST
OSCEOLA WI
54020-4120
US

IV. Provider business mailing address

375 280TH ST
OSCEOLA WI
54020-4120
US

V. Phone/Fax

Practice location:
  • Phone: 715-294-2144
  • Fax: 715-294-2006
Mailing address:
  • Phone: 715-294-2144
  • Fax: 715-294-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateWI

VIII. Authorized Official

Name: DR. GOTTFRIED KELLERMANN
Title or Position: OWNER PRESIDENT
Credential: PHD
Phone: 715-294-2144