# AGNESIAN HEALTHCARE ENTERPRISES LLC

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

## Provider details

- **NPI number:** 1174145031
- **Authorized official:** KIMBERLY SPENCER (SYSTEM VP PHARMACY SERVICES)
- **Authorized official phone:** (920) 926-6011

## Contact information

- **Practice address:** 904 W MAIN ST, WAUPUN, WI 53963-1201
- **Practice address phone:** (920) 324-8703
- **Practice address fax:** (920) 324-3476
- **Mailing address:** 145 N MAIN ST, FOND DU LAC, WI 54935-3423
- **Mailing address phone:** (920) 926-6010
- **Mailing address fax:** (920) 926-6046

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 05/14/2020
- **Last updated:** 06/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 33272300 | — | WI |