# E.A. MCCULLOUGH, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** McCullough's Prescriptions and Gifts
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043329824
- **Authorized official:** MR. JAMES EDWARD MCCULLOUGH RPH (PRESIDENT)
- **Authorized official phone:** (262) 248-6226

## Contact information

- **Practice address:** 269 BROAD ST, LAKE GENEVA, WI 53147-1809
- **Practice address phone:** (262) 248-6226
- **Mailing address:** 694 S WELLS ST, LAKE GENEVA, WI 53147-2106
- **Mailing address phone:** (262) 248-8582
- **Mailing address fax:** (262) 248-8593

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 4700 | WI | Yes |

## Other

- **Enumeration date:** 08/29/2006
- **Last updated:** 02/04/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 33108300 | — | WI |