Individual
STEPHEN TANGULIE TONSONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
3710 57TH AVE, KENOSHA, WI 53144-4820
(262) 652-1474
Mailing address
3710 57TH AVE, KENOSHA, WI 53144-4820
(262) 652-1474
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
20215-40
WI
3336C0003X
Community/Retail Pharmacy
Primary
20215-40
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1965179
PHARMACIST
WI
01
—
20215-40
PHARMACIST
WI
Enumeration date
12/27/2020
Last updated
12/27/2020
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