Individual
COLLEEN KOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
900 E MAIN ST, WATERFORD, WI 53185-4536
(262) 514-4290
Mailing address
W230S8995 CLARK ST, BIG BEND, WI 53103-9479
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
19135-40
WI
Other
Enumeration date
02/25/2020
Last updated
02/25/2020
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