Individual
KELLY ANN DATKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
21325 E MORELAND BLVD, WAUKESHA, WI 53186-2909
(262) 798-0223
Mailing address
21325 E MORELAND BLVD, WAUKESHA, WI 53186-2909
(262) 798-0223
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
19490-40
WI
Other
Enumeration date
02/20/2020
Last updated
02/20/2020
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