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General NPI Number Information
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NPI Number | 1295847119
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Entity Type | Organization
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Legal Business Name | THE PHARMACY OF NEW LONDON INC.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1301 MILL ST
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City | NEW LONDON
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State | WI
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Zip | 54961-2153
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Country | US
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Telephone | 920-982-7670
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Fax | 920-982-7686
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Provider Business Mailing Address
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Address Line | 1301 MILL ST
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City | NEW LONDON
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State | WI
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Zip | 54961-2153
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Country | US
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Telephone | 920-982-7670
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Fax | 920-982-7686
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | JIM JERNEGAN
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Credential | RPH
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Telephone | 920-982-7670
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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 | 6861
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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