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General NPI Number Information
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NPI Number | 1528173572
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Entity Type | Organization
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Legal Business Name | CROSS PLAINS PHARMACY LLC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 1840 MAIN ST
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City | CROSS PLAINS
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State | WI
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Zip | 53528-9473
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Country | US
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Telephone | 608-798-3031
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Fax | 608-798-3932
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Provider Business Mailing Address
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Address Line | PO BOX 215
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City | CROSS PLAINS
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State | WI
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Zip | 53528-0215
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Country | US
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Telephone | 608-798-3031
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Fax | 608-798-3932
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Authorized Official
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Title or Position | OWNER
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Name | LISA KOSTECKI
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Credential | RPH
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Telephone | 608-798-3031
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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 |
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License Number State |
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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 | 829842
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License Number State | WI
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