Healthcare Provider Details

I. General information

NPI: 1760591531
Provider Name (Legal Business Name): MARSHLAND PHARMACIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 WASHINGTON STREET
HORICON WI
53032-1587
US

IV. Provider business mailing address

700 WASHINGTON STREET
HORICON WI
53032-1587
US

V. Phone/Fax

Practice location:
  • Phone: 920-485-3400
  • Fax: 920-485-3409
Mailing address:
  • Phone: 920-485-3400
  • Fax: 920-485-3409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number9059-042
License Number StateWI

VIII. Authorized Official

Name: SUSAN L SUTTER
Title or Position: MANAGING PHARMACIST
Credential: R.PH.
Phone: 920-485-3400