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Organization
FORUM EXTENDED CARE SERVICES OF WISCONSIN INC
Active
Organization
FORUM EXTENDED CARE SERVICES OF WISCONSIN INC
Active
Other names
Willow Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN KRAMER (PRESIDENT)
(847) 673-8727
Entity
Organization
Contact information
Practice address
2445 DARWIN RD, SUITE 102, MADISON, WI 53704-3116
(608) 240-2280
(608) 240-2288
Mailing address
4201 W VICTORIA ST, CHICAGO, IL 60646-6700
(847) 673-8727
(847) 673-6215
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
9417-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100001648
—
WI
01
—
2117872
PK
—
Enumeration date
10/16/2008
Last updated
03/22/2022
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