MEDICARE: CARDINS 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	3336C0003X	Community/Retail Pharmacy	8803-042	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	:	1881690576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDINS PHARMACY, INC

Provider Business Mailing Address
First Line	:	117 W. WEBSTER STREET
Second Line	:
City	:	CUBA CITY
State	:	WI
Zip	:	53807-1538
Country	:	US
Telephone Number	:	608-744-2195
Fax Number	:	608-744-2193

Provider Business Practice Location Address
First Line	:	117 W. WEBSTER STREET
Second Line	:
City	:	CUBA CITY
State	:	WI
Zip	:	53807-1538
Country	:	US
Telephone Number	:	608-744-2195
Fax Number	:	608-744-2193

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	MR. JON JOSEPH WILSON
Credential	:	RPH
Telephone Number	:	608-744-2195

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	10/27/2009

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Directions to “CARDINS PHARMACY, INC ” Practice Location

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