Healthcare Provider Details

I. General information

NPI: 1497766232
Provider Name (Legal Business Name): WHITE CROSS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 SILVER ST
HURLEY WI
54534-1254
US

IV. Provider business mailing address

138 2ND AVE N
PARK FALLS WI
54552-1214
US

V. Phone/Fax

Practice location:
  • Phone: 715-561-5666
  • Fax: 715-561-5654
Mailing address:
  • Phone: 715-762-3283
  • Fax: 715-762-2980

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 Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8951-42
License Number StateWI

VIII. Authorized Official

Name: MARK PECHACEK
Title or Position: PRESIDENT
Credential:
Phone: 715-762-3283