Provider Demographics
NPI:1972780096
Name:KRUEGER, DAVID ALLEN (DPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLEN
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3423
Mailing Address - Country:US
Mailing Address - Phone:920-926-4660
Mailing Address - Fax:920-922-5011
Practice Address - Street 1:145 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3423
Practice Address - Country:US
Practice Address - Phone:920-926-4660
Practice Address - Fax:920-922-5011
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14489-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist