Individual
KEITH WAYNE HEROLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2440 W MASON ST, GREEN BAY, WI 54303-4711
(920) 499-2330
(920) 499-1136
Mailing address
2080 SWEETFERN DR, GREEN BAY, WI 54313-4366
(920) 676-6422
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12269-040
WI
Other
Enumeration date
10/19/2020
Last updated
11/03/2020
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