Individual
JANE MARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
203 N MAIN ST, LAKE MILLS, WI 53551-1610
(920) 648-3455
(920) 648-2712
Mailing address
203 N MAIN ST, LAKE MILLS, WI 53551-1610
(920) 648-3455
(920) 648-2712
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11761-40
WI
Other
Enumeration date
11/05/2012
Last updated
11/05/2012
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