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General NPI Number Information
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NPI Number | 1194990796
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Entity Type | Organization
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Legal Business Name | MEMORIAL HOSPITAL PHARMACY
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 205 PARKER ST
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City | BOSCOBEL
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State | WI
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Zip | 53805-1642
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Country | US
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Telephone | 608-375-6307
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Fax | 608-375-6198
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Provider Business Mailing Address
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Address Line | 205 PARKER ST
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City | BOSCOBEL
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State | WI
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Zip | 53805-1642
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Country | US
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Telephone | 608-375-6307
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Fax | 608-375-6198
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | MR. DOUGLAS JAMES KNOBLE
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Credential | R.PH.
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Telephone | 608-375-6307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 6785-042
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License Number State | WI
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