Individual
RANDALL L ATHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
925 E WALL ST, EAGLE RIVER, WI 54521-8720
(715) 479-6413
(715) 479-4621
Mailing address
PO BOX 1059, EAGLE RIVER, WI 54521-1059
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10151-40
WI
Other
Enumeration date
10/16/2012
Last updated
10/16/2012
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