| NPI | 1801873476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORLISS STOXEN President 715-361-4770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WI 8397-42) |
| Additional Taxonomies | 3336S0011X Pharmacy, Specialty Pharmacy |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 333600000X Pharmacy | |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2017-04-21 |