Healthcare Provider Details

I. General information

NPI: 1699793380
Provider Name (Legal Business Name): COMMUNITY PHARMACY CO-OPERATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 FAIROAKS AVE
MADISON WI
53704
US

IV. Provider business mailing address

130 FAIROAKS AVE.
MADISON WI
53704
US

V. Phone/Fax

Practice location:
  • Phone: 608-251-4454
  • Fax: 608-251-3853
Mailing address:
  • Phone: 608-251-4454
  • Fax: 608-251-3853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number6464
License Number StateWI

VIII. Authorized Official

Name: DR. AIMEE SPEERS
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM D
Phone: 608-251-4454