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Organization
LAYTON PHARMACY SC
Active
Organization
LAYTON PHARMACY SC
Active
Other names
MIDTOWN PHARMACY 4
Organization subpart
No
Provider details
NPI number
Authorized official
DHARMESH GHELANI PHARM D (PRESIDENT)
(414) 800-4070
Entity
Organization
Contact information
Practice address
2741 W LAYTON AVE STE 105, MILWAUKEE, WI 53221-2600
(414) 800-4070
(414) 800-4068
Mailing address
2741 W LAYTON AVE STE 105, MILWAUKEE, WI 53221-2600
(414) 800-4070
(414) 800-4068
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9607-42
STATE LIC
WI
Enumeration date
10/03/2019
Last updated
10/03/2019
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