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General NPI Number Information
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NPI Number | 1699793380
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Entity Type | Organization
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Legal Business Name | COMMUNITY PHARMACY CO-OPERATIVE
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 130 FAIROAKS AVE
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City | MADISON
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State | WI
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Zip | 53704
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Country | US
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Telephone | 608-251-4454
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Fax | 608-251-3853
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Provider Business Mailing Address
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Address Line | 130 FAIROAKS AVE.
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City | MADISON
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State | WI
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Zip | 53704
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Country | US
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Telephone | 608-251-4454
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Fax | 608-251-3853
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | DR. AIMEE SPEERS
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Credential | PHARM D
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Telephone | 608-251-4454
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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 | 6464
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License Number State | WI
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Taxonomy #2
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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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