Healthcare Provider Details

I. General information

NPI: 1902845381
Provider Name (Legal Business Name): WHITFORD PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 MAIN ST
DARLINGTON WI
53530-1425
US

IV. Provider business mailing address

327 MAIN ST
DARLINGTON WI
53530-1425
US

V. Phone/Fax

Practice location:
  • Phone: 608-776-4481
  • Fax: 608-776-2341
Mailing address:
  • Phone: 608-776-4481
  • Fax: 608-776-2341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8099
License Number StateWI

VIII. Authorized Official

Name: MR. WILLIAM J WHITFORD
Title or Position: OWNER
Credential: RPH
Phone: 608-776-4481