MEDICARE: OSTERBAUER DRUGS LTD

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	3336C0003X	Community/Retail Pharmacy	9117-42	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
2	5109067	OTHER		NCPDP

General Provider Information

NPI Number	:	1922175066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSTERBAUER DRUGS LTD

Provider Business Mailing Address
First Line	:	312 W KNAPP ST
Second Line	:
City	:	RICE LAKE
State	:	WI
Zip	:	54868-1631
Country	:	US
Telephone Number	:	715-234-3969
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 W KNAPP ST
Second Line	:
City	:	RICE LAKE
State	:	WI
Zip	:	54868-1631
Country	:	US
Telephone Number	:	715-234-3969
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. DANIEL OSTERBAUER
Credential	:	RPH
Telephone Number	:	715-234-3969

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	04/12/2012

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