# BADGER ACQUISITION OF WISCONSIN, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Luther Haven Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568568913
- **Authorized official:** JONATHAN D KUKULSKI (CORPORATE SECRETARY)
- **Authorized official phone:** (513) 719-2600

## Contact information

- **Practice address:** 8949 N 97TH ST, MILWAUKEE, WI 53224-1695
- **Practice address phone:** (414) 354-8554
- **Practice address fax:** (414) 354-8521
- **Mailing address:** 201 E 4TH ST, 900 OMNICARE CENTER, CINCINNATI, OH 45202-4248
- **Mailing address phone:** (513) 719-2600

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332BP3500X | Parenteral & Enteral Nutrition Supplies (DME) | 032006914 | WI | — |
| 3336L0003X | Long Term Care Pharmacy | 032006914 | WI | Yes |

## Other

- **Enumeration date:** 09/15/2006
- **Last updated:** 09/15/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 33232400 | — | WI |
| 01 | — | 5119145 | NCPDP | WI |