Individual
SAMANTHA RAE DEBARTOLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1810 30TH AVE, KENOSHA, WI 53144-1437
(262) 551-8812
Mailing address
1810 30TH AVE, KENOSHA, WI 53144-1437
(262) 551-8812
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2269040
WI
Other
Enumeration date
07/31/2024
Last updated
07/31/2024
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