MEDICARE: STOXEN PHARMACY

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	333600000X	Pharmacy	6389	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	:	1962480707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STOXEN PHARMACY

Provider Business Mailing Address
First Line	:	12 W WISCONSIN AVENUE
Second Line	:
City	:	TOMAHAWK
State	:	WI
Zip	:	54487
Country	:	US
Telephone Number	:	715-453-3110
Fax Number	:	715-453-4469

Provider Business Practice Location Address
First Line	:	12 W WISCONSIN AVENUE
Second Line	:
City	:	TOMAHAWK
State	:	WI
Zip	:	54487
Country	:	US
Telephone Number	:	715-453-3110
Fax Number	:	715-453-4469

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CORLISS J STOXEN
Credential	:	RPH
Telephone Number	:	715-361-4770

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	07/26/2011

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Directions to “STOXEN PHARMACY ” Practice Location

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