| NPI | 1649217878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI L SOERENS Billing Manager 920-803-3260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WI 7654) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2020-08-22 |