| NPI | 1912720814 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA BERGH Pharmacy Manager 414-721-6816 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy Compounding Pharmacy |
| Additional Taxonomies | 3336M0002X Pharmacy Mail Order Pharmacy |
| Enumeration Date | 2024-11-07 |
| Last Update Date | 2024-11-07 |