Provider Demographics
NPI:1225208036
Name:BRESSERS, KENNETH ALLEN (R PH)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ALLEN
Last Name:BRESSERS
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OMRO
Mailing Address - State:WI
Mailing Address - Zip Code:54963-1415
Mailing Address - Country:US
Mailing Address - Phone:920-685-5041
Mailing Address - Fax:920-685-0313
Practice Address - Street 1:109 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OMRO
Practice Address - State:WI
Practice Address - Zip Code:54963-1415
Practice Address - Country:US
Practice Address - Phone:920-685-5041
Practice Address - Fax:920-685-0313
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8878040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist