Provider Demographics
NPI:1700370947
Name:BOMKAMP, KEIRA MONET (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEIRA
Middle Name:MONET
Last Name:BOMKAMP
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2057
Mailing Address - Country:US
Mailing Address - Phone:608-251-4454
Mailing Address - Fax:
Practice Address - Street 1:341 STATE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2057
Practice Address - Country:US
Practice Address - Phone:608-251-4454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19333-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist