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General NPI Number Information
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NPI Number | 1164932091
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Entity Type | Organization
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Legal Business Name | MABIE PHARMACY, LLC
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Dates
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Enumeration Date | 10/05/2017
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 10 LIBERTY ST # 106
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City | DEERFIELD
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State | WI
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Zip | 53531-9458
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Country | US
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Telephone | 608-764-1500
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Fax | 608-764-1600
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Provider Business Mailing Address
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Address Line | PO BOX 406
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City | DEERFIELD
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State | WI
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Zip | 53531-0406
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Country | US
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Telephone | 608-764-1500
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Fax | 608-764-1600
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Authorized Official
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Title or Position | OWNER
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Name | MR. MATTHEW RYAN MABIE
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Credential | RPH
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Telephone | 608-347-5420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 9485-042
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 9485-042
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 9485-042
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License Number State | WI
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