=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881406239
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONROE HOMETOWN PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2025
-----------------------------------------------------
Last Update Date | 09/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1008 17TH AVE
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53566-2005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-325-2151
-----------------------------------------------------
Fax | 608-325-2153
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 LOWVILLE RD
-----------------------------------------------------
City | RIO
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53960-9437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-992-6800
-----------------------------------------------------
Fax | 920-614-6100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTRACTING MANAGER
-----------------------------------------------------
Name | DANIEL STRAUSE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 920-992-6800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------