Organization Name: | WISCONSIN CVS PHARMACY LLC |
NPI Number: | 1376899120 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS) |
Mailing Address: | 4301 W Wisconsin Ave Ste 42 Appleton |
State: | WI US |
Postal Code: | 549136524 |
Phone Number: | 9202437877 |
Fax Number: | |
NPI Enumeration Date: | 07/31/2012 |
NPI Last Update Date: | 01/11/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
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 |