Healthcare Provider Details

I. General information

NPI: 1821081936
Provider Name (Legal Business Name): MAPLEWOOD OF SAUK PRAIRIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 SYCAMORE STEET
SAUK CITY WI
53583
US

IV. Provider business mailing address

245 SYCAMORE STEET
SAUK CITY WI
53583
US

V. Phone/Fax

Practice location:
  • Phone: 608-644-9265
  • Fax: 608-643-2629
Mailing address:
  • Phone: 608-644-9265
  • Fax: 608-643-2629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD CARL HARRIS
Title or Position: STAFF PHARMACIST
Credential: R.PH.
Phone: 608-644-9265