Individual
KEVIN STARAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11111 W BURLEIGH ST, WAUWATOSA, WI 53222-3211
(414) 290-0910
Mailing address
11111 W BURLEIGH ST, WAUWATOSA, WI 53222-3211
(414) 290-0910
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
19344
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19344-40
PHARMACIST LICENSE
WI
Enumeration date
09/21/2018
Last updated
09/21/2018
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