# MEQUON FAMILY PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538609292
- **Authorized official:** LAURA MUGURDUMOVA (CEO)
- **Authorized official phone:** (262) 581-0411

## Contact information

- **Practice address:** 1424 W MEQUON RD, MEQUON, WI 53092-3226
- **Practice address phone:** (262) 581-0411
- **Practice address fax:** (262) 923-1002
- **Mailing address:** 1424 W MEQUON RD, MEQUON, WI 53092-3226
- **Mailing address phone:** (262) 581-0411
- **Mailing address fax:** (262) 923-1002

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 02/28/2017
- **Last updated:** 04/11/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2168769 | PK | — |