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General NPI Number Information
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NPI Number | 1891098976
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Entity Type | Organization
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Legal Business Name | EDGERTON HOSPITAL AND HEALTH SERVICES
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 11101 N SHERMAN RD
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City | EDGERTON
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State | WI
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Zip | 53534-9002
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Country | US
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Telephone | 608-884-1586
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Fax |
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Provider Business Mailing Address
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Address Line | 6501 CITY WEST PKWY
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-3248
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Country | US
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Telephone | 952-653-2568
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | TODD CROWLEY
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Credential |
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Telephone | 952-653-2568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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