Healthcare Provider Details

I. General information

NPI: 1629162268
Provider Name (Legal Business Name): SPRING GREEN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/08/2016
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

208 E JEFFERSON ST
SPRING GREEN WI
53588-8002
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number6137-042
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number6137
License Number StateWI

VIII. Authorized Official

Name: ALISHA M HAHN
Title or Position: OWNER
Credential: R.PH.
Phone: 608-588-2541