| NPI | 1821989872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNNSI GULLICKSRUD Practice Administrator 715-835-6548 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2025-07-09 |
| Last Update Date | 2025-07-09 |