| NPI | 1891729018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANNE THEDE Billing Manager 920-803-3263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: WI 7616) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2008-01-25 |