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General NPI Number Information
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NPI Number | 1679801807
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Entity Type | Organization
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Legal Business Name | KCJE FORD INC
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Dates
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Enumeration Date | 11/30/2009
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Last Update Date | 08/11/2016
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Provider Practice Location Address
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Address Line | 505 KING ST STE 154
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City | LA CROSSE
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State | WI
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Zip | 54601-4062
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Country | US
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Telephone | 608-782-4448
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Fax | 608-782-4449
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Provider Business Mailing Address
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Address Line | PO BOX 2496
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City | LA CROSSE
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State | WI
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Zip | 54602-2496
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Country | US
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Telephone | 608-782-4448
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Fax | 608-782-4449
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Authorized Official
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Title or Position | PHARMACY TECHNICIAN
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Name | KRISTY BASSEUNER
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Credential |
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Telephone | 608-784-9922
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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 | 9122-042
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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 |
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License Number State |
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