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General NPI Number Information
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NPI Number | 1477676971
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Entity Type | Organization
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Legal Business Name | HOLY FAMILY MEMORIAL, INC
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 06/16/2015
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Provider Practice Location Address
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Address Line | 2300 WESTERN AVE
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City | MANITOWOC
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State | WI
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Zip | 54220-3712
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Country | US
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Telephone | 920-320-2273
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Fax | 920-320-3578
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Provider Business Mailing Address
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Address Line | 2300 WESTERN AVE
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City | MANITOWOC
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State | WI
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Zip | 54220-3712
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Country | US
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Telephone | 920-320-2273
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Fax | 920-320-3578
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | MRS. DARLENE M. WIEGAND
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Credential | PHARMACIST
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Telephone | 920-320-2274
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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 | 3205-042
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License Number State | WI
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