MEDICARE: MR. WADE LEE ANDERSON RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	12604	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093992703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WADE LEE ANDERSON RPH

Provider Business Mailing Address
First Line	:	50 N MAIN ST
Second Line	:	PO BOX 51
City	:	DEERFIELD
State	:	WI
Zip	:	53531-9453
Country	:	US
Telephone Number	:	608-764-8111
Fax Number	:	608-764-5556

Provider Business Practice Location Address
First Line	:	50 N MAIN ST
Second Line	:
City	:	DEERFIELD
State	:	WI
Zip	:	53531-9453
Country	:	US
Telephone Number	:	608-764-8111
Fax Number	:	608-764-5556

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	01/24/2008

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