# PORT FAMILY PHARMACY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184353807
- **Authorized official:** DR. MICHAEL J VINEBURG PHARMD. (OWNER)
- **Authorized official phone:** (262) 261-3900

## Contact information

- **Practice address:** 1021 N WISCONSIN ST, PORT WASHINGTON, WI 53074-1207
- **Practice address phone:** (262) 261-3900
- **Mailing address:** 1021 N WISCONSIN ST, PORT WASHINGTON, WI 53074-1207

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 06/08/2022
- **Last updated:** 05/04/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100216135 | — | WI |