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Organization
VILLAGE BAKE SHOP INC
Active
Organization
VILLAGE BAKE SHOP INC
Active
Other names
QUILLINS MAJOR DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES BERG RPH (HEAD PHARMACIST)
(608) 784-6200
Entity
Organization
Contact information
Practice address
3954 MORMON COULEE RD, LA CROSSE, WI 54601-7916
(608) 784-6200
(608) 784-3808
Mailing address
3954 MORMON COULEE RD, LA CROSSE, WI 54601-7916
(608) 784-6200
(608) 784-3808
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
7708-42
WI
3336L0003X
Long Term Care Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33060500
—
WI
01
—
5104687
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
636560400
—
MN
Enumeration date
09/30/2006
Last updated
05/19/2010
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