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Organization
RESTORE HEALTH PHARMACY, LLC
Active
Organization
RESTORE HEALTH PHARMACY, LLC
Active
Other names
Restore Health Pharmacy, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW WANDERER PHARMD (CEO)
(480) 421-8005
Entity
Organization
Contact information
Practice address
1289 DEMING WAY, MADISON, WI 53717-2007
(800) 558-7046
(888) 898-7412
Mailing address
1289 DEMING WAY, MADISON, WI 53717-2007
(800) 558-7046
(888) 898-7412
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
9070-042
WI
3336C0004X
Compounding Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2130190
PK
—
Enumeration date
05/06/2011
Last updated
02/23/2015
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