Healthcare Provider Details

I. General information

NPI: 1629530837
Provider Name (Legal Business Name): ABBOTSFORD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N 4TH ST
ABBOTSFORD WI
54405-9413
US

IV. Provider business mailing address

206 N 4TH ST
ABBOTSFORD WI
54405-9413
US

V. Phone/Fax

Practice location:
  • Phone: 715-715-7216
  • Fax: 715-316-0021
Mailing address:
  • Phone: 715-721-6068
  • Fax: 715-316-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PAIGE WILES
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 715-418-3478