Individual
CIARAN PATRICK KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2950 NEW PINERY RD, PORTAGE, WI 53901-9225
(608) 742-1670
Mailing address
6337 HARTFORD DR, MADISON, WI 53719-4801
(806) 790-7219
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
19537-40
WI
Other
Enumeration date
10/21/2020
Last updated
10/21/2020
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