| NPI | 1174509046 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK BORTNEM Chief Finanicial Officer 715-838-5270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy (Licence: WI 7132) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2025-08-20 |