Individual
ADAM DEBRUIN SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
842 N WESTHILL BLVD, APPLETON, WI 54914-5788
(877) 667-4689
Mailing address
842 N WESTHILL BLVD, APPLETON, WI 54914-5788
(877) 667-4689
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
0202210659
VA
183500000X
Pharmacist
051.037489
IL
183500000X
Pharmacist
12294-40
WI
183500000X
Pharmacist
Primary
PS24518
FL
183500000X
Pharmacist
S019033
AZ
Other
Enumeration date
05/17/2012
Last updated
05/17/2012
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