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General NPI Number Information
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NPI Number | 1568568913
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Entity Type | Organization
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Legal Business Name | BADGER ACQUISITION OF WISCONSIN, LLC
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 09/15/2014
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Provider Practice Location Address
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Address Line | 8949 N 97TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53224-1695
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Country | US
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Telephone | 414-354-8554
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Fax | 414-354-8521
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Provider Business Mailing Address
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Address Line | 201 E 4TH ST 900 OMNICARE CENTER
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City | CINCINNATI
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State | OH
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Zip | 45202-4248
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Country | US
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Telephone | 513-719-2600
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Fax |
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Authorized Official
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Title or Position | CORPORATE SECRETARY
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Name | JONATHAN D KUKULSKI
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Credential |
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Telephone | 513-719-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 032006914
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License Number State | WI
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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 | 032006914
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License Number State | WI
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