Individual
MR. MARK STEPHEN VANDERMAUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS PHARMACY RPH
Contact information
Practice address
2412 CROOKS AVE, KAUKAUNA, WI 54130-3914
(920) 759-9165
Mailing address
N4086 COUNTY ROAD C, FREEDOM, WI 54913-7759
(920) 832-4065
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
9249-40
WI
Other
Enumeration date
10/24/2011
Last updated
10/24/2011
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