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Organization
BELLICOSE INTERNATIONAL INC.
Active
Organization
BELLICOSE INTERNATIONAL INC.
Active
Other names
Wood River Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SELMA DZELIL PHARMD (VP RDO)
(815) 715-8502
Entity
Organization
Contact information
Practice address
122 W MADISON AVE, GRANTSBURG, WI 54840-7022
(715) 463-2525
(715) 463-5343
Mailing address
122 W MADISON AVE, GRANTSBURG, WI 54840-7022
(715) 463-2525
(715) 463-5343
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
6872
WI
333600000X
Pharmacy
Primary
6872
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000086607
MEDICARE
WI
05
—
33154200
—
WI
01
—
5106047
NABP
WI
Enumeration date
06/14/2005
Last updated
09/25/2023
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