| NPI | 1194582221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGAN ELIZABETH CONKLIN Pharmacist 920-912-7029 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 3336C0002X Pharmacy Clinic Pharmacy |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| Enumeration Date | 2024-03-05 |
| Last Update Date | 2024-03-05 |