Individual
LUKE VANDERMAUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
116 N MILITARY AVE, GREEN BAY, WI 54303-3202
(920) 498-3247
Mailing address
116 N MILITARY AVE, GREEN BAY, WI 54303-3202
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
16786-40
WI
Other
Enumeration date
08/11/2012
Last updated
08/11/2012
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