1518042944 NPI number — SCHULTZ PHARMACY INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518042944 NPI number — SCHULTZ PHARMACY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHULTZ PHARMACY INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518042944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1008 17TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53566-2005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-325-2151
Provider Business Mailing Address Fax Number:
608-325-2153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1008 17TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53566-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-325-2151
Provider Business Practice Location Address Fax Number:
608-325-2153
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULTZ
Authorized Official First Name:
JEANNE
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
SEC OF CORP
Authorized Official Telephone Number:
608-325-2151

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  7669 042 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 33122200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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