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General NPI Number Information
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NPI Number | 1194823138
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Entity Type | Organization
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Legal Business Name | MEDICAL PHARMACY
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | N84W16889 MENOMONEE AVE
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-2810
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Country | US
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Telephone | 262-251-8500
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Fax | 262-251-8994
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Provider Business Mailing Address
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Address Line | N84W16889 MENOMONEE AVE
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-2810
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRES
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Name | ROBERT BUTH
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Credential |
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Telephone | 202-251-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 7460042
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License Number State | WI
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