Individual
REBECCA STARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARM.D.
Contact information
Practice address
192 N MAIN ST, FOND DU LAC, WI 54935-3462
(920) 921-5264
Mailing address
2461 SCENIC DR, KEWASKUM, WI 53040-9713
(262) 510-6953
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
15441-40
WI
Other
Enumeration date
10/27/2011
Last updated
10/27/2011
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