Provider Demographics
NPI:1497389613
Name:KULAGA, CAROL (RPH)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:KULAGA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8951 COUNTY ROAD II UNIT A3
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:WI
Mailing Address - Zip Code:54940-9663
Mailing Address - Country:US
Mailing Address - Phone:920-594-2662
Mailing Address - Fax:
Practice Address - Street 1:925 W FULTON ST
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-1479
Practice Address - Country:US
Practice Address - Phone:715-258-9228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11813-40183500000X
WI11813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist