Provider Demographics
NPI:1558643387
Name:KEMNA, DARYL FRANCIS (RPH)
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:FRANCIS
Last Name:KEMNA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STATE HIGHWAY 13
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN DELLS
Mailing Address - State:WI
Mailing Address - Zip Code:53965-7902
Mailing Address - Country:US
Mailing Address - Phone:608-254-5760
Mailing Address - Fax:608-253-9733
Practice Address - Street 1:300 STATE HIGHWAY 13
Practice Address - Street 2:
Practice Address - City:WISCONSIN DELLS
Practice Address - State:WI
Practice Address - Zip Code:53965-7902
Practice Address - Country:US
Practice Address - Phone:608-254-5760
Practice Address - Fax:608-253-9733
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15398-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist