Individual
KONG VANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
3518 MEMORIAL DR, MADISON, WI 53704-1574
(608) 628-0256
Mailing address
PO BOX 164, COTTAGE GROVE, WI 53527-0164
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13997
WI
Other
Enumeration date
12/06/2011
Last updated
12/06/2011
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