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General NPI Number Information
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NPI Number | 1245363563
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Entity Type | Organization
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Legal Business Name | THEDA CLARK PHARMACY
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 130 2ND ST
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City | NEENAH
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State | WI
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Zip | 54956-2883
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Country | US
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Telephone | 920-729-3090
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Fax |
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Provider Business Mailing Address
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Address Line | 130 2ND ST
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City | NEENAH
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State | WI
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Zip | 54956-2883
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Country | US
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Telephone | 920-729-3090
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. WILLIAM FLETT
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Credential |
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Telephone | 920-454-4013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 3273
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License Number State | WI
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