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General NPI Number Information
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NPI Number | 1508947185
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Entity Type | Organization
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Legal Business Name | SAUK CITY PHARMACY INC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 830 WATER ST
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City | SAUK CITY
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State | WI
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Zip | 53583
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Country | US
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Telephone | 608-643-6858
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Fax | 608-643-4196
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Provider Business Mailing Address
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Address Line | 830 WATER ST
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City | SAUK CITY
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State | WI
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Zip | 53583
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Country | US
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Telephone | 608-643-6858
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Fax | 608-643-4196
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Authorized Official
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Title or Position | PRES
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Name | MR. KEVIN LEE BLESSING
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Credential | RPH
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Telephone | 608-643-6858
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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 | G637042
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License Number State | WI
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