Individual
DALE E KANAK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
822 BROADWAY ST, BERLIN, WI 54923-1300
(920) 361-3433
(920) 361-0235
Mailing address
W3559 MEREDITH LN, GREEN LAKE, WI 54941-9650
(920) 295-6233
(920) 295-4556
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12591-040
WI
Other
Enumeration date
06/13/2006
Last updated
07/08/2007
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