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NPI Code Detail

MEDICARE: SHELL LAKE PHARMACY LTD

MEDICARE: SHELL LAKE PHARMACY LTD
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
1332B00000XDurable Medical Equipment & Medical Supplies
23336L0003XLong Term Care Pharmacy

General Provider Information

NPI Number : 1962920926
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHELL LAKE PHARMACY LTD
Provider Business Mailing Address
First Line : PO BOX 343
Second Line :
City : SHELL LAKE
State : WI
Zip : 54871-0343
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 113 4TH AVE
Second Line :
City : SHELL LAKE
State : WI
Zip : 54871-4457
Country : US
Telephone Number : 715-468-7800
Fax Number :
Authorized Official
Title or Position : ADMINISTRATIVE ASSISTANT
Name : PAIGE WILES
Credential :
Telephone Number : 715-418-3478
Provider Enumeration Date : 08/30/2017
Last Update Date : 02/03/2020

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Directions to “SHELL LAKE PHARMACY LTD ” Practice Location

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