MEDICARE: SPRING GREEN PHARMACY INC

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	3336L0003X	Long Term Care Pharmacy	6137	WI
2	3336C0003X	Community/Retail Pharmacy	6137-042	WI

General Provider Information

NPI Number	:	1629162268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRING GREEN PHARMACY INC

Provider Business Mailing Address
First Line	:	208 E JEFFERSON ST
Second Line	:
City	:	SPRING GREEN
State	:	WI
Zip	:	53588-8002
Country	:	US
Telephone Number	:	608-588-2541
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 E JEFFERSON ST
Second Line	:
City	:	SPRING GREEN
State	:	WI
Zip	:	53588-8002
Country	:	US
Telephone Number	:	608-588-2541
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALISHA M HAHN
Credential	:	R.PH.
Telephone Number	:	608-588-2541

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/08/2016

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