Individual
JONATHAN LANCOURT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
900 E MAIN ST, WATERFORD, WI 53185-4536
(262) 514-4290
Mailing address
900 E MAIN ST, WATERFORD, WI 53185-4536
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
17557-40
WI
Other
Enumeration date
07/30/2014
Last updated
02/14/2016
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