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Organization
PAMIDA STORES OPERATING CO LLC
Active
Organization
PAMIDA STORES OPERATING CO LLC
Active
Other names
Pamida Pharmacy 108
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN HARLOW (CEO/PRESIDENT)
(402) 596-7206
Entity
Organization
Contact information
Practice address
1011 E SPRUCE ST, ABBOTSFORD, WI 54405-9647
(715) 223-2480
(715) 223-2663
Mailing address
1011 E SPRUCE ST, ABBOTSFORD, WI 54405-9647
(715) 223-2480
(715) 223-2663
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
8590042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33270500
—
WI
01
—
5127483
NCPDP NUMBER
—
Enumeration date
05/20/2006
Last updated
11/23/2009
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