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General NPI Number Information
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NPI Number | 1508376682
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Entity Type | Organization
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Legal Business Name | MABIE PHARMACY, LLC
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Dates
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Enumeration Date | 10/03/2017
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 429 W COTTAGE GROVE RD
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City | COTTAGE GROVE
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State | WI
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Zip | 53527-9385
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Country | US
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Telephone | 608-839-3335
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Fax | 608-839-3336
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Provider Business Mailing Address
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Address Line | 429 W COTTAGE GROVE RD
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City | COTTAGE GROVE
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State | WI
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Zip | 53527-9385
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Country | US
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Telephone | 608-839-3335
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Fax | 608-839-3336
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Authorized Official
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Title or Position | OWNER
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Name | MR. MATTHEW RYAN MABIE
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Credential | RPH
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Telephone | 608-347-5420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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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 | 9483-042
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 9483-042
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 9483-042
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License Number State | WI
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