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General NPI Number Information
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NPI Number | 1376615575
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Entity Type | Organization
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Legal Business Name | KAUKAUNA PRESCRIPTION CENTER
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 200 E 2ND ST
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City | KAUKAUNA
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State | WI
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Zip | 54130-2524
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Country | US
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Telephone | 920-766-9200
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Fax | 920-766-7998
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Provider Business Mailing Address
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Address Line | 200 E 2ND ST
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City | KAUKAUNA
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State | WI
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Zip | 54130-2524
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER AND CEO
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Name | JEROME WALLENFANG
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Credential | RPH
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Telephone | 920-766-9200
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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 | 8079042
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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 |
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License Number State |
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