NPI 1679843700

Grass Roots Health Foods

Organisation Medical Foods Supplier Eagle River, WI

Practice location

Address: 3440 State Highway 70 E, Eagle River, WI 54521-9491
Phone: (715) 479-6299

Authorised official

Name: David G. Koller
Title: Owner
Phone: (715) 479-6299

Registered specialties

Medical Foods Supplier Primary

Suppliers Taxonomy 335G00000X

Other Medical Foods Supplier providers in Wisconsin →

Registry record

NPI: 1679843700
Entity type: Organization
NPI issued: 5 Jan 2012
Record last updated: 21 Jul 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.