Healthcare Provider Details

I. General information

NPI: 1326145152
Provider Name (Legal Business Name): ELKHORN PHARMACY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 E GENEVA ST
ELKHORN WI
53121-2301
US

IV. Provider business mailing address

603 EAST GENEVA STREET
ELKHORN WI
53121
US

V. Phone/Fax

Practice location:
  • Phone: 262-723-8444
  • Fax: 262-723-8760
Mailing address:
  • Phone: 262-723-8444
  • Fax: 262-723-8760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MAY HERNING KUE
Title or Position: OWNER/MANAGER
Credential: PHARM D
Phone: 262-723-8444