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Organization
IV COMPOUND CENTER OF WISCONSIN LLC
Active
Organization
IV COMPOUND CENTER OF WISCONSIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD STEVEN KOSHAK RPH (OWNER)
(262) 641-2850
Entity
Organization
Contact information
Practice address
5478 S WESTRIDGE DR, NEW BERLIN, WI 53151-7948
(262) 641-2850
(262) 641-2854
Mailing address
5478 S WESTRIDGE DR, NEW BERLIN, WI 53151-7948
(262) 641-2850
(262) 641-2854
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
8543-042
WI
Other
Enumeration date
03/30/2013
Last updated
03/30/2013
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