Healthcare Provider Details

I. General information

NPI: 1275521528
Provider Name (Legal Business Name): DENNIS L. HUNT PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 E MAIN ST
OMRO WI
54963-1420
US

IV. Provider business mailing address

328 E MAIN ST
OMRO WI
54963-1420
US

V. Phone/Fax

Practice location:
  • Phone: 920-685-5041
  • Fax: 920-685-0313
Mailing address:
  • Phone: 920-685-5041
  • Fax: 920-685-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8049
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH ALLEN BRESSERS
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 920-685-5041