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General NPI Number Information
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NPI Number | 1770532384
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Entity Type | Organization
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Legal Business Name | WEST SALEM PHARMACY LLC
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 880 MILL ST N
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City | WEST SALEM
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State | WI
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Zip | 54669-2213
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Country | US
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Telephone | 608-786-0210
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Fax | 608-786-0211
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Provider Business Mailing Address
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Address Line | PO BOX 185
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City | WEST SALEM
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State | WI
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Zip | 54669-0185
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Country | US
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Telephone | 608-786-0210
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Fax | 608-786-0211
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Authorized Official
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Title or Position | PHARMACY MGR
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Name | AMY BRIESKE
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Credential |
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Telephone | 608-786-0210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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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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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 9004-42
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License Number State | WI
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