Healthcare Provider Details

I. General information

NPI: 1568993210
Provider Name (Legal Business Name): SPRING GREEN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E JEFFERSON ST
SPRING GREEN WI
53588-8002
US

IV. Provider business mailing address

PO BOX 69
SPRING GREEN WI
53588-0069
US

V. Phone/Fax

Practice location:
  • Phone: 608-588-2541
  • Fax: 608-588-2884
Mailing address:
  • Phone: 608-588-2541
  • Fax: 608-588-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number6137-42
License Number StateWI

VIII. Authorized Official

Name: ALISHA HAHN
Title or Position: CO OWNER AND VP
Credential:
Phone: 608-588-2541