Provider Demographics
NPI:1962779140
Name:PLZAK, KEVIN J (RPH)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:J
Last Name:PLZAK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 E NAWADA ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5271
Mailing Address - Country:US
Mailing Address - Phone:920-268-8903
Mailing Address - Fax:
Practice Address - Street 1:1900 S KOELLER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-6153
Practice Address - Country:US
Practice Address - Phone:920-233-4287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10892-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist