Individual
MS. MARY FANSHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
607 PARK AVE, BEAVER DAM, WI 53916-2201
(920) 356-0148
Mailing address
N7976 N CRYSTAL LAKE RD, BEAVER DAM, WI 53916-9383
(920) 382-2269
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
21537-40
WI
Other
Enumeration date
05/08/2024
Last updated
05/08/2024
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