Healthcare Provider Details

I. General information

NPI: 1326123498
Provider Name (Legal Business Name): RAABE'S PHARMACY S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S ADAMS ST
NEW LISBON WI
53950-1206
US

IV. Provider business mailing address

112 S ADAMS ST
NEW LISBON WI
53950-1206
US

V. Phone/Fax

Practice location:
  • Phone: 608-562-3302
  • Fax: 608-562-3951
Mailing address:
  • Phone: 608-562-3302
  • Fax: 608-562-3951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number6695-042
License Number StateWI

VIII. Authorized Official

Name: THOMAS A. RAABE
Title or Position: PRESIDENT
Credential: RPH
Phone: 608-562-3302