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General NPI Number Information
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NPI Number | 1568993210
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Entity Type | Organization
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Legal Business Name | SPRING GREEN PHARMACY INC
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Dates
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Enumeration Date | 03/24/2017
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 208 E JEFFERSON ST
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City | SPRING GREEN
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State | WI
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Zip | 53588-8002
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Country | US
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Telephone | 608-588-2541
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Fax | 608-588-2884
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Provider Business Mailing Address
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Address Line | PO BOX 69
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City | SPRING GREEN
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State | WI
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Zip | 53588-0069
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Country | US
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Telephone | 608-588-2541
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Fax | 608-588-2884
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Authorized Official
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Title or Position | CO OWNER AND VP
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Name | ALISHA HAHN
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Credential |
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Telephone | 608-588-2541
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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 | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 6137-42
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License Number State | WI
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