# GWIDT PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GWIDT PHARMACY INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407861008
- **Authorized official:** SHANE RESCH (PRESIDENT)
- **Authorized official phone:** (715) 253-2164

## Contact information

- **Practice address:** 203 E WESTGOR AVE, WITTENBERG, WI 54499-9174
- **Practice address phone:** (715) 253-2164
- **Practice address fax:** (715) 253-3030
- **Mailing address:** PO BOX 253, WITTENBERG, WI 54499-0253

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 291U00000X | Clinical Medical Laboratory | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 8440042 | WI | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 07/30/2006
- **Last updated:** 08/01/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2113260 | PK | — |
| 05 | — | 33102800 | — | WI |