Healthcare Provider Details

I. General information

NPI: 1801873476
Provider Name (Legal Business Name): STOXEN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 N SHORE DR
RHINELANDER WI
54501-6710
US

IV. Provider business mailing address

333 LOWVILLE RD
RIO WI
53960-9437
US

V. Phone/Fax

Practice location:
  • Phone: 715-361-4770
  • Fax: 715-369-3650
Mailing address:
  • Phone: 920-992-6800
  • Fax: 920-992-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8397-42
License Number StateWI

VIII. Authorized Official

Name: CORLISS STOXEN
Title or Position: PRESIDENT
Credential: BS PHARMACY
Phone: 715-361-4770