Individual
JEREMY NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
700 WEST AVE S, LA CROSSE, WI 54601-4783
(608) 785-0940
Mailing address
2501 32ND ST S APT 4, LA CROSSE, WI 54601-7491
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
14963
WI
Other
Enumeration date
08/24/2007
Last updated
08/24/2007
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