| NPI | 1447521927 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY PANTEL Billing Supervisor 920-803-3266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: WI 9408) |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy (Licence: WI 9395) |
| Enumeration Date | 2012-01-16 |
| Last Update Date | 2016-08-31 |