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Organization
AGNESIAN HEALTHCARE ENTERPRISES LLC
Active
Organization
AGNESIAN HEALTHCARE ENTERPRISES LLC
Active
Other names
Agnesian Pharmacy Waupun
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY SPENCER (SYSTEM VP PHARMACY SERVICES)
(920) 926-6011
Entity
Organization
Contact information
Practice address
904 W MAIN ST, WAUPUN, WI 53963-1201
(920) 324-8703
(920) 324-3476
Mailing address
145 N MAIN ST, FOND DU LAC, WI 54935-3423
(920) 926-6010
(920) 926-6046
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33272300
—
WI
Enumeration date
05/14/2020
Last updated
06/07/2023
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