Individual
KELLY VANDERLOOP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1060 E JOHNSON ST, FOND DU LAC, WI 54935-8900
(920) 266-4323
Mailing address
620 E PIONEER RD APT 8, FOND DU LAC, WI 54935-6531
(920) 378-8780
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
21134
WI
Other
Enumeration date
09/30/2021
Last updated
09/30/2021
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