| NPI | 1851109821 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARA ANN PAUL Specialist, Contracting & Audit 608-310-1823 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336S0011X Pharmacy, Specialty Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| 3336M0002X Pharmacy, Mail Order Pharmacy | |
| Enumeration Date | 2024-12-23 |
| Last Update Date | 2024-12-23 |