Provider Demographics
NPI:1760576755
Name:PHARMASAN LABS INC
Entity Type:Organization
Organization Name:PHARMASAN LABS INC
Other - Org Name:NEUROSCIENCE INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GOTTFRIED
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:715-294-2144
Mailing Address - Street 1:375 280TH ST
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54020-4120
Mailing Address - Country:US
Mailing Address - Phone:715-294-2144
Mailing Address - Fax:715-294-2006
Practice Address - Street 1:375 280TH ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:WI
Practice Address - Zip Code:54020-4120
Practice Address - Country:US
Practice Address - Phone:715-294-2144
Practice Address - Fax:715-294-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN30F23PHOtherBCBS PROVIDER NUMBER
WI7751240OtherAETNA
WI34-0031OtherMEDICA PROVIDER NUMBER
WI34-0031OtherMEDICA PROVIDER NUMBER
WI=========020OtherBCBS