| NPI | 1386190247 |
|---|---|
| Doing Business As | PROVIDENCE FAMILY PHARMACY LLC |
| Entity Type | Organization |
| Authorized Contact | ABIOLA OKUSANYA Manager 414-885-0550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WI 9428-42) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336L0003X Pharmacy, Long Term Care Pharmacy | |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2020-02-20 |