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Organization
VAN'S CORNER DRUG
Active
Organization
VAN'S CORNER DRUG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK J VANDELIST RPH (PHARMACIST)
(920) 324-5211
Entity
Organization
Contact information
Practice address
401 E MAIN ST, WAUPUN, WI 53963-2161
(920) 324-5211
(920) 324-4360
Mailing address
401 E MAIN ST, WAUPUN, WI 53963-2161
(920) 324-5211
(920) 324-4360
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
7714-042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33226400
—
WI
01
—
5114373
NCPDP
WI
Enumeration date
10/26/2006
Last updated
08/22/2020
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