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Organization
THEDACARE MEDICAL CENTER-BERLIN INC
Active
Organization
THEDACARE MEDICAL CENTER-BERLIN INC
Active
Other names
ThedaCare Pharmacy - Wautoma
Organization subpart
No
Provider details
NPI number
Authorized official
ALISSA GIES PHARM D (PHARMACIST OF RECORD)
(920) 787-5757
Entity
Organization
Contact information
Practice address
N2934 HWY 22 N, WAUTOMA, WI 54982-5267
(920) 787-5757
(920) 787-5382
Mailing address
N2934 HWY 22 N, WAUTOMA, WI 54982
(920) 787-5757
(920) 787-5382
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
7733-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2108771
PK
—
05
—
33230600
—
WI
Enumeration date
12/11/2006
Last updated
04/18/2017
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