Healthcare Provider Details

I. General information

NPI: 1043269020
Provider Name (Legal Business Name): WAUPACA WOODS PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N WESTERN AVE
WAUPACA WI
54981-2201
US

IV. Provider business mailing address

101 N WESTERN AVE
WAUPACA WI
54981-2201
US

V. Phone/Fax

Practice location:
  • Phone: 715-258-7621
  • Fax: 715-258-6880
Mailing address:
  • Phone: 715-258-7621
  • Fax: 715-258-6880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number7463
License Number StateWI

VIII. Authorized Official

Name: KAREN M. STEDMAN
Title or Position: INSURANCE SPECIALIST
Credential:
Phone: 715-258-7621