# GWIDT PHARMACY INC

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

## Provider details

- **NPI number:** 1649501586
- **Authorized official:** SHANE RESCH (VICE-PRESIDENT)
- **Authorized official phone:** (715) 253-2164

## Contact information

- **Practice address:** 203 E WESTGOR AVE, SUITE 1, WITTENBERG, WI 54499-9174
- **Practice address phone:** (715) 253-2164
- **Practice address fax:** (715) 253-3030
- **Mailing address:** PO BOX 253, WITTENBERG, WI 54499-0253
- **Mailing address phone:** (715) 253-2164
- **Mailing address fax:** (715) 253-3030

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 8989-42 | WI | Yes |

## Other

- **Enumeration date:** 01/15/2010
- **Last updated:** 08/12/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2123642 | PK | — |