| NPI | 1679835326 |
|---|---|
| Doing Business As | 13TH STREET PHARMACY LLC |
| Entity Type | Organization |
| Authorized Contact | RUSSEL SHTIVELBERG Member 414-324-9393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WI 9131-42) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2014-12-03 |