Individual
KIEFER SAMP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
301 W MAIN ST, WATERTOWN, WI 53094-7629
(920) 206-9588
Mailing address
301 W MAIN ST, WATERTOWN, WI 53094-7629
(920) 206-9588
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
22361-40
WI
Other
Enumeration date
10/19/2023
Last updated
10/19/2023
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