Healthcare Provider Details

I. General information

NPI: 1821415258
Provider Name (Legal Business Name): RUSK COUNTY PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 W 9TH ST N
LADYSMITH WI
54848-1269
US

IV. Provider business mailing address

312 W 9TH ST N
LADYSMITH WI
54848-1269
US

V. Phone/Fax

Practice location:
  • Phone: 715-532-3339
  • Fax: 715-532-3330
Mailing address:
  • Phone: 715-532-3339
  • Fax: 715-532-3330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number9251-42
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA J PROHASKA
Title or Position: OWNER
Credential:
Phone: 715-415-1891