MEDICARE: NEWCASTLE PLACE INC PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy	8282042	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184721615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWCASTLE PLACE INC PHARMACY

Provider Business Mailing Address
First Line	:	12600 N PORT WASHINGTON RD
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-3469
Country	:	US
Telephone Number	:	262-387-8888
Fax Number	:	262-387-8829

Provider Business Practice Location Address
First Line	:	12600 N PORT WASHINGTON RD
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-3469
Country	:	US
Telephone Number	:	262-387-8888
Fax Number	:	262-387-8829

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	MR. ROBERT MAILE
Credential	:	RPH
Telephone Number	:	262-387-8888

Provider Enumeration Date	:	09/19/2006
Last Update Date	:	08/22/2020

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