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General NPI Number Information
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NPI Number | 1174322846
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Entity Type | Organization
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Legal Business Name | LA CLINICA DE LOS CAMPESINOS, INC
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 400 S TOWNLINE RD
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City | WAUTOMA
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State | WI
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Zip | 54982-6922
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Country | US
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Telephone | 920-647-8984
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Fax | 920-647-8991
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Provider Business Mailing Address
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Address Line | 400 S TOWNLINE RD
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City | WAUTOMA
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State | WI
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Zip | 54982-6922
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Country | US
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Telephone | 920-647-8984
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Fax | 920-647-8991
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | KELLEN DORFF
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Credential |
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Telephone | 920-647-8984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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