| NPI | 1659473767 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY PANTEL Billing Supervisor 920-803-3266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: WI 8682) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WI 8682) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2009-10-13 |