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General NPI Number Information
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NPI Number | 1770589897
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Entity Type | Organization
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Legal Business Name | FMPS LLC
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 03/27/2015
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Provider Practice Location Address
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Address Line | 121 FRENCH ST
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City | PESHTIGO
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State | WI
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Zip | 54157-1215
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Country | US
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Telephone | 715-582-4140
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Fax | 715-582-4196
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Provider Business Mailing Address
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Address Line | 121 FRENCH ST
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City | PESHTIGO
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State | WI
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Zip | 54157-1215
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Country | US
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Telephone | 715-582-4140
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Fax | 715-582-4196
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Authorized Official
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Title or Position | CEO
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Name | GUY STILLWELL
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Credential |
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Telephone | 651-270-0038
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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 | 9303-42
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License Number State | WI
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