| Organization Name: | SHELL LAKE PHARMACY LTD |
| NPI Number: | 1356413850 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOSHUA J PROHASKA (OWNER) |
| Mailing Address: | 108 4th Ave W Shell Lake |
| State: | WI US |
| Postal Code: | 54871 |
| Phone Number: | 7154687800 |
| Fax Number: | 7154687921 |
| NPI Enumeration Date: | 11/14/2006 |
| NPI Last Update Date: | 07/26/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 6461042 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |