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General NPI Number Information
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NPI Number | 1366417917
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Entity Type | Organization
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Legal Business Name | AGNESIAN HEALTHCARE INC
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Dates
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Enumeration Date | 02/17/2006
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 904 W MAIN ST
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City | WAUPUN
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State | WI
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Zip | 53963-1201
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Country | US
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Telephone | 920-324-3010
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Fax | 920-324-3875
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Provider Business Mailing Address
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Address Line | 904 W MAIN ST
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City | WAUPUN
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State | WI
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Zip | 53963-1201
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Country | US
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Telephone | 920-324-3010
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Fax | 920-324-4370
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Authorized Official
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Title or Position | FINANCE VICE PRESIDENT WI REGION
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Name | AMY JO GRINNELL
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Credential |
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Telephone | 608-260-3586
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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