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Organization
MIDE INC.
Active
Organization
MIDE INC.
Active
Other names
Wolf River Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA MOIOFFER (PRESIDENT)
(715) 781-3058
Entity
Organization
Contact information
Practice address
600 E PIONEER ST STE 3, CRANDON, WI 54520-1662
(715) 478-3369
(715) 478-3945
Mailing address
600 E PIONEER ST STE 3, CRANDON, WI 54520-1662
(715) 478-3369
(715) 478-3945
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
7069042
WI
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33134200
—
WI
Enumeration date
01/25/2007
Last updated
11/05/2024
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