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General NPI Number Information
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NPI Number | 1619926854
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Entity Type | Organization
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Legal Business Name | TARGET PHARMACY T-1060
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Dates
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Enumeration Date | 05/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 201 JUNCTION RD
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City | MADISON
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State | WI
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Zip | 53717-2615
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Country | US
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Telephone | 608-827-9483
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Fax | 608-827-9483
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Provider Business Mailing Address
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Address Line | 201 JUNCTION RD
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City | MADISON
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State | WI
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Zip | 53717-2615
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Country | US
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Telephone | 608-827-9483
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Fax | 608-827-9483
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Authorized Official
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Title or Position | PHARMACY TEAM LEADER
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Name | CHARLIE LEE
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Credential | RPH
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Telephone | 608-827-9483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 8075
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License Number State | WI
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