# SHELL LAKE PHARMACY LTD

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

## Provider details

- **NPI number:** 1356413850
- **Authorized official:** PAIGE WILES (ADMIN ASSISTANT)
- **Authorized official phone:** (715) 418-3478

## Contact information

- **Practice address:** 113 4TH AVE, SHELL LAKE, WI 54871-4457
- **Practice address phone:** (715) 468-7800
- **Practice address fax:** (715) 468-7921
- **Mailing address:** PO BOX 343, SHELL LAKE, WI 54871-0343
- **Mailing address phone:** (715) 468-7800
- **Mailing address fax:** (715) 468-7921

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 6461042 | WI | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 11/14/2006
- **Last updated:** 10/04/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 33038100 | — | WI |