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Individual

MR. WILLIAM J SUPALLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RPH

Contact information

Practice address
322 S STATE ST, FIVE LAKES CENTRE, FAIRMONT, MN 56031-4139
(507) 238-2797
(507) 238-4701
Mailing address
3819 CEDAR CREEK CT, FAIRMONT, MN 56031-2432
(507) 235-8541

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
111504-6
MN

Other

Enumeration date
02/03/2007
Last updated
07/08/2007
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