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General NPI Number Information
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NPI Number | 1275860785
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Entity Type | Organization
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Legal Business Name | DAHLSTROMS INC
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Dates
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Enumeration Date | 11/05/2009
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Last Update Date | 11/05/2009
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Provider Practice Location Address
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Address Line | 37 5TH AVE
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City | SHELL LAKE
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State | WI
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Zip | 54871-0236
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Country | US
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Telephone | 715-468-2319
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Fax | 715-468-4140
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Provider Business Mailing Address
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Address Line | 37 5TH AVE PO BOX 236
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City | SHELL LAKE
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State | WI
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Zip | 54871
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Country | US
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Telephone | 715-468-2319
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Fax | 715-468-4140
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN O DAHLSTROM
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Credential |
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Telephone | 715-468-2319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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