Healthcare Provider Details

I. General information

NPI: 1982649760
Provider Name (Legal Business Name): YELLOW RIVER PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7438 MAIN ST W
WEBSTER WI
54893-8206
US

IV. Provider business mailing address

PO BOX 26
WEBSTER WI
54893-0026
US

V. Phone/Fax

Practice location:
  • Phone: 715-866-8644
  • Fax: 715-866-7344
Mailing address:
  • Phone: 715-866-8644
  • Fax: 715-866-7344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8806042
License Number StateWI

VIII. Authorized Official

Name: ERICA PAFFEL
Title or Position: PRESIDENT
Credential: PHRMD
Phone: 715-866-8644