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General NPI Number Information
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NPI Number | 1730503517
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Entity Type | Organization
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Legal Business Name | THE PHARMACY STATION INC
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Dates
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Enumeration Date | 02/13/2014
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 300 S PINE ST
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City | BURLINGTON
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State | WI
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Zip | 53105-2235
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Country | US
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Telephone | 262-763-8877
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Fax |
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Provider Business Mailing Address
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Address Line | 397 ROBINS RUN
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City | BURLINGTON
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State | WI
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Zip | 53105-1073
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Country | US
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Telephone | 262-763-6969
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JARED SPITZER
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Credential |
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Telephone | 262-763-8877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 9158-40
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License Number State | WI
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