Individual
DR. BENJAMIN WILLIAM KOMISTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD, RPH
Contact information
Practice address
4924 7TH AVE, KENOSHA, WI 53140-3349
(262) 997-9573
(262) 997-9574
Mailing address
4924 7TH AVE, KENOSHA, WI 53140-3349
(262) 997-9573
(262) 997-9574
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
19339-40
WI
Other
Enumeration date
09/29/2022
Last updated
09/29/2022
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