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Individual

DR. KENNETH RUSSELL TENNESSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHARMD

Contact information

Practice address
301 W MAIN ST, WATERTOWN, WI 53094-7629
(920) 206-9585
(920) 206-9702
Mailing address
301 W MAIN ST, WATERTOWN, WI 53094-7629
(920) 206-9585
(920) 206-9702

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
17098-40
WI

Other

Enumeration date
07/17/2013
Last updated
07/18/2013
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