Healthcare Provider Details

I. General information

NPI: 1194854422
Provider Name (Legal Business Name): HOTEL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1696 N ASTOR ST
MILWAUKEE WI
53202-2164
US

IV. Provider business mailing address

1696 N ASTOR ST
MILWAUKEE WI
53202-2164
US

V. Phone/Fax

Practice location:
  • Phone: 414-272-4384
  • Fax: 414-278-8724
Mailing address:
  • Phone: 414-272-4384
  • Fax: 414-278-8724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number6551
License Number StateWI

VIII. Authorized Official

Name: MR. JAMES L SEARLES
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 414-272-4384