Individual
MR. CLYDE JOSEPH NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2500 OVERLOOK TER, PHARMACY DEPT, MADISON, WI 53705-2254
(608) 256-1901
(608) 280-7279
Mailing address
7203 DONNA DR, MIDDLETON, WI 53562-1733
(608) 836-8263
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
7203
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7203
PHARMACY LICENSE
WI
Enumeration date
09/16/2006
Last updated
07/08/2007
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