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General NPI Number Information
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NPI Number | 1528625985
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Entity Type | Organization
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Legal Business Name | BELLICOSE INTERNATIONAL INC.
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Dates
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Enumeration Date | 05/21/2019
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 122 W MADISON AVE
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City | GRANTSBURG
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State | WI
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Zip | 54840-7022
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Country | US
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Telephone | 715-463-2525
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Fax | 715-463-5343
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Provider Business Mailing Address
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Address Line | PO BOX 39
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City | GRANTSBURG
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State | WI
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Zip | 54840-0039
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Country | US
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Telephone | 715-463-2525
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Fax | 715-463-5343
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Authorized Official
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Title or Position | MANAGER
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Name | MR. CHRISTOPHER JOHN WITZANY
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Credential | R.PH.
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Telephone | 715-463-2525
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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 |
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License Number State |
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