Provider Demographics
NPI:1073156758
Name:KOLAR, KENNETH S (PHARMD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:S
Last Name:KOLAR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:3304 SHADY LN
Practice Address - Street 2:
Practice Address - City:SUAMICO
Practice Address - State:WI
Practice Address - Zip Code:54313-8712
Practice Address - Country:US
Practice Address - Phone:920-503-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13282-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty