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Organization
GRASS ROOTS HEALTH FOODS
Active
Organization
GRASS ROOTS HEALTH FOODS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID G. KOLLER (OWNER)
(715) 479-6299
Entity
Organization
Contact information
Practice address
3440 STATE HIGHWAY 70 E, EAGLE RIVER, WI 54521-9491
(715) 479-6299
Mailing address
3440 STATE HIGHWAY 70 E, EAGLE RIVER, WI 54521-9491
Taxonomy
Speciality
Code
Description
License number
State
335G00000X
Medical Foods Supplier
Primary
—
WI
Other
Enumeration date
01/05/2012
Last updated
07/21/2022
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