Healthcare Provider Details

I. General information

NPI: 1518950872
Provider Name (Legal Business Name): DALY DRUG, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 8TH ST S
WISCONSIN RAPIDS WI
54494-6564
US

IV. Provider business mailing address

3215 8TH ST S
WISCONSIN RAPIDS WI
54494-6564
US

V. Phone/Fax

Practice location:
  • Phone: 715-423-3400
  • Fax: 715-423-5504
Mailing address:
  • Phone: 715-423-3400
  • Fax: 715-423-5504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6119
License Number StateWI

VIII. Authorized Official

Name: MR. PAUL L. NELSON
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 715-423-3400