Healthcare Provider Details

I. General information

NPI: 1841399730
Provider Name (Legal Business Name): MARSHLAND DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 HORICON ST
MAYVILLE WI
53050-1429
US

IV. Provider business mailing address

1028 HORICON ST
MAYVILLE WI
53050-1429
US

V. Phone/Fax

Practice location:
  • Phone: 920-387-7800
  • Fax: 920-387-7809
Mailing address:
  • Phone: 920-387-7800
  • Fax: 920-387-7809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8060042
License Number StateWI

VIII. Authorized Official

Name: STACI WILLIAMS
Title or Position: MANAGER
Credential: PHARMD
Phone: 920-387-7800