# BADGER PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Young's Drug Store
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073628020
- **Authorized official:** FORREST YOUNG RPH (OWNER)
- **Authorized official phone:** (715) 842-0370

## Contact information

- **Practice address:** 310 E BRIDGE ST, WAUSAU, WI 54403-3589
- **Practice address phone:** (715) 845-5203
- **Practice address fax:** (715) 843-0883
- **Mailing address:** 555 S 72ND AVE, WAUSAU, WI 54401-9038
- **Mailing address phone:** (715) 842-0370
- **Mailing address fax:** (715) 842-0366

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 8995-42 | WI | Yes |

## Other

- **Enumeration date:** 08/20/2006
- **Last updated:** 08/04/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1073628020 | — | WI |
| 01 | — | 5113600 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |