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Organization
GOOD HARVEST MARKET
Active
Organization
GOOD HARVEST MARKET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BECKY FAMULARO (BOOKKEEPER)
(262) 544-9380
Entity
Organization
Contact information
Practice address
1850 MEADOW LN, PEWAUKEE, WI 53072-5572
(262) 544-9380
Mailing address
1850 MEADOW LANE, PEWAUKEE, WI 53072
(262) 544-9380
Taxonomy
Speciality
Code
Description
License number
State
335G00000X
Medical Foods Supplier
Primary
—
—
Other
Enumeration date
05/14/2012
Last updated
05/14/2012
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