| NPI | 1104517176 |
|---|---|
| Doing Business As | PHARMACY COMPOUNDING |
| Entity Type | Organization |
| Authorized Contact | THOMAS BRIESKE Owner 608-386-9039 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy, Compounding Pharmacy |
| Enumeration Date | 2023-05-18 |
| Last Update Date | 2023-05-18 |