# FORUM EXTENDED CARE SERVICES OF WISCONSIN INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Willow Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013169598
- **Authorized official:** BRIAN KRAMER (PRESIDENT)
- **Authorized official phone:** (847) 673-8727

## Contact information

- **Practice address:** 2445 DARWIN RD, SUITE 102, MADISON, WI 53704-3116
- **Practice address phone:** (608) 240-2280
- **Practice address fax:** (608) 240-2288
- **Mailing address:** 4201 W VICTORIA ST, CHICAGO, IL 60646-6700
- **Mailing address phone:** (847) 673-8727
- **Mailing address fax:** (847) 673-6215

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 9417-42 | WI | Yes |

## Other

- **Enumeration date:** 10/16/2008
- **Last updated:** 03/22/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100001648 | — | WI |
| 01 | — | 2117872 | PK | — |