Healthcare Provider Details

I. General information

NPI: 1588058309
Provider Name (Legal Business Name): PCD CLARY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 N MAIN ST
RICHLAND CENTER WI
53581-2238
US

IV. Provider business mailing address

157 N MAIN ST
RICHLAND CENTER WI
53581-2238
US

V. Phone/Fax

Practice location:
  • Phone: 608-649-2944
  • Fax: 608-649-2945
Mailing address:
  • Phone: 608-649-2944
  • Fax: 608-649-2945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: PENNY CLARY
Title or Position: MEMBER/OWNER
Credential:
Phone: 608-649-2944