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Organization
LAKE MILLS HOMETOWN PHARMACY LLC
Active
Organization
LAKE MILLS HOMETOWN PHARMACY LLC
Active
Other names
LAKE MILLS HOMETOWN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL STRAUSE (CEO)
(920) 992-6800
Entity
Organization
Contact information
Practice address
372 E TYRANENA PARK RD, LAKE MILLS, WI 53551-9680
(920) 945-2500
(920) 945-2503
Mailing address
333 LOWVILLE RD, RIO, WI 53960-9437
(920) 992-6800
(920) 992-6801
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
9469-42
WI
3336S0011X
Specialty Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100070330
—
WI
Enumeration date
06/26/2017
Last updated
06/24/2020
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