Healthcare Provider Details

I. General information

NPI: 1245249614
Provider Name (Legal Business Name): BOSCOBEL PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 WISCONSIN AVE
BOSCOBEL WI
53805-1532
US

IV. Provider business mailing address

1028 WISCONSIN AVE
BOSCOBEL WI
53805-1532
US

V. Phone/Fax

Practice location:
  • Phone: 608-375-4466
  • Fax: 608-375-2383
Mailing address:
  • Phone: 608-375-4466
  • Fax: 608-375-2383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number6474-042
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number6474-042
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number6474-042
License Number StateWI
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number6474-042
License Number StateWI

VIII. Authorized Official

Name: DR. MICHELLE E. FARRELL
Title or Position: PHARMACIST, OWNER
Credential: PHARMD
Phone: 608-375-4466