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General NPI Number Information
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NPI Number | 1629520879
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Entity Type | Organization
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Legal Business Name | MBMC MAUSTON PHILLIPS LLC
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 406 GATEWAY AVE
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City | MAUSTON
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State | WI
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Zip | 53948-1401
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Country | US
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Telephone | 608-847-5949
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Fax | 608-847-5199
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Provider Business Mailing Address
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Address Line | 406 GATEWAY AVE
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City | MAUSTON
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State | WI
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Zip | 53948-1401
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Country | US
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Telephone | 608-847-5949
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Fax | 608-847-5199
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Authorized Official
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Title or Position | VP - CFO
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Name | THOMAS KAMINSKI
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Credential |
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Telephone | 608-847-1452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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