| NPI | 1114078904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFERY J GOTTFRIED Pharmacist 262-679-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WI 7799) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2020-08-22 |