Individual
DANIEL KICKERTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
816 FEATHERSTONE RD, ROCKFORD, IL 61107-6300
(815) 227-0081
Mailing address
816 FEATHERSTONE RD, ROCKFORD, IL 61107-6300
(815) 227-0081
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051033042
IL
Other
Enumeration date
10/18/2019
Last updated
10/18/2019
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