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General NPI Number Information
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NPI Number | 1952477903
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Entity Type | Organization
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Legal Business Name | ELLSWORTH VILLAGE PHARMACY INC.
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 183 E MAIN ST
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City | ELLSWORTH
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State | WI
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Zip | 54011-9188
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Country | US
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Telephone | 715-273-4466
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Fax | 715-273-5414
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Provider Business Mailing Address
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Address Line | 183 E MAIN ST
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City | ELLSWORTH
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State | WI
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Zip | 54011-9188
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Country | US
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Telephone | 715-273-4466
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Fax | 715-273-5414
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOEL C. SCHULZE
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Credential | RPH.
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Telephone | 715-273-4466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 8321-040
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License Number State | WI
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