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General NPI Number Information
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NPI Number | 1205164597
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Entity Type | Organization
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Legal Business Name | BADGER PHARMACY LLC
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 301 E 2ND ST
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City | MERRILL
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State | WI
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Zip | 54452-2317
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Country | US
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Telephone | 715-536-2909
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Fax | 715-536-5094
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Provider Business Mailing Address
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Address Line | 555 S 72ND AVE
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City | WAUSAU
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State | WI
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Zip | 54401-9038
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Country | US
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Telephone | 715-842-0370
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Fax | 715-842-0366
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Authorized Official
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Title or Position | OWNER
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Name | FORREST YOUNG
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Credential |
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Telephone | 715-842-0370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 9172-42
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 9172-42
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License Number State | WI
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