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General NPI Number Information
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NPI Number | 1942331467
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Entity Type | Organization
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Legal Business Name | STOCKBRIDGE MUNSEE COMMUNITY
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 12/04/2008
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Provider Practice Location Address
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Address Line | W12802 COUNTY ROAD A
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City | BOWLER
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State | WI
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Zip | 54416-0086
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Country | US
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Telephone | 715-793-4144
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Fax | 715-793-4120
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Provider Business Mailing Address
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Address Line | W12802 COUNTY ROAD A
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City | BOWLER
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State | WI
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Zip | 54416-0086
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Country | US
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Telephone | 715-793-4144
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Fax | 715-793-4120
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT CHICKS
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Credential |
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Telephone | 715-793-4111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332800000X
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Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
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License Number |
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License Number State |
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