| NPI | 1215302773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN JAY LINCOLN Staff Pharmacist 262-567-7938 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: WI R9740-40) |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2015-12-09 |