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General NPI Number Information
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NPI Number | 1568418929
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Entity Type | Organization
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Legal Business Name | FROEDTERT HEALTH PHARMACY LLC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 1650 S. 41ST STREET
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City | MANITOWOC
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State | WI
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Zip | 54220
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Country | US
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Telephone | 920-320-4400
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Fax | 920-320-5104
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Provider Business Mailing Address
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Address Line | N86W12999 NIGHTINGALE WAY
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051
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Country | US
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Telephone | 262-532-5173
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Fax | 262-532-5105
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Authorized Official
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Title or Position | EXEC DIR FH PHARMACY SOLUTIONS
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Name | DALE DRIZD
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Credential |
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Telephone | 262-532-5168
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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 |
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License Number State |
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