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General NPI Number Information
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NPI Number | 1497898472
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Entity Type | Organization
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Legal Business Name | STREUS PHARMACY INC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 02/29/2008
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Provider Practice Location Address
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Address Line | 528 N MONROE AVE
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City | GREEN BAY
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State | WI
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Zip | 54301-4910
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Country | US
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Telephone | 920-437-0206
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Fax | 920-884-6932
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Provider Business Mailing Address
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Address Line | 528 N MONROE AVE
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City | GREEN BAY
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State | WI
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Zip | 54301-4910
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Country | US
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Telephone | 920-437-0206
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Fax | 920-884-6932
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | MR. JEFFREY A KIRCHNER
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Credential | RPH
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Telephone | 920-437-0206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 8504-042
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License Number State | WI
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