# GWIDT PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** OCONTO FALLS PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245319912
- **Authorized official:** TIMOTHY STARRY B.S. PHARM (PRESIDENT)
- **Authorized official phone:** (920) 848-3721

## Contact information

- **Practice address:** 323 E HIGHLAND DR, OCONTO FALLS, WI 54154-1006
- **Practice address phone:** (920) 848-3721
- **Practice address fax:** (920) 848-4374
- **Mailing address:** PO BOX 129, OCONTO FALLS, WI 54154-0129
- **Mailing address phone:** (920) 848-3721
- **Mailing address fax:** (920) 848-4374

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 7999-42 | WI | Yes |

## Other

- **Enumeration date:** 11/03/2006
- **Last updated:** 05/01/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2112905 | PK | — |
| 05 | — | 33213600 | — | WI |