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Organization
MC 5 INC
Active
Organization
MC 5 INC
Active
Other names
MCCULLOUGH'S LTC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT MCCULLOUGH (PRESIDENT)
(262) 473-5087
Entity
Organization
Contact information
Practice address
1173 W MAIN ST, STE F, WHITEWATER, WI 53190-1672
(262) 473-5087
(262) 473-7357
Mailing address
1173 W MAIN ST, STE F, WHITEWATER, WI 53190-1672
(262) 473-5087
(262) 473-7357
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
885142
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2116684
PK
—
Enumeration date
07/10/2008
Last updated
08/21/2019
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