Kenneth Scott Nelson, PHARMD
Individual provider Active NPI Pharmacist · Luck, WI
NPI 1548219694 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1548219694
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 11412-040 (WI)
- Practice address
- 132 S. Main
Luck Pharmacy Inc
Luck, WI 54853 - Phone
- (715) 472-2122
- NPI assigned
- May 8, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11412-040 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Luck Pharmacy Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 11412-040 | WI | Yes |
Addresses
Primary practice location
132 S. Main
Luck Pharmacy Inc
Luck, WI 54853
Mailing address
402 Rock Ridge TRL
Milltown, WI 54858-4421
Phone (715) 825-7979
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33273100 | Medicaid | WI |
Other providers in Luck, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.