Shane Kloppenburg
Pharmacist in Watertown, WI. Individual provider (NPI-1).
NPI number1164055778
StatusActive
Last updated in NPPESFeb 21, 2020
Details
- NPI
- 1164055778
- Entity type
- Individual (NPI-1)
- Name
- Shane Kloppenburg
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 21, 2020
- Certification date
- Feb 21, 2020
- Last updated
- Feb 21, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 183500000X | Pharmacist | 19877 | WI | Yes |
Practice location
301 W Main StWatertown, WI 53094-7629
Phone 920-206-9588
Mailing address
301 W Main StWatertown, WI 53094-7629
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