MEDICARE: MARSHLAND PHARMACIES, 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	3336C0003X	Community/Retail Pharmacy	9059-042	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	:	1760591531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARSHLAND PHARMACIES, INC

Provider Business Mailing Address
First Line	:	700 WASHINGTON STREET
Second Line	:
City	:	HORICON
State	:	WI
Zip	:	53032-1587
Country	:	US
Telephone Number	:	920-485-3400
Fax Number	:	920-485-3409

Provider Business Practice Location Address
First Line	:	700 WASHINGTON STREET
Second Line	:
City	:	HORICON
State	:	WI
Zip	:	53032-1587
Country	:	US
Telephone Number	:	920-485-3400
Fax Number	:	920-485-3409

Authorized Official
Title or Position	:	MANAGING PHARMACIST
Name	:	SUSAN L SUTTER
Credential	:	R.PH.
Telephone Number	:	920-485-3400

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	05/05/2015

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Directions to “MARSHLAND PHARMACIES, INC ” Practice Location

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