# RESTORE HEALTH PHARMACY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Restore Health Pharmacy, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750673919
- **Authorized official:** MATTHEW WANDERER PHARMD (CEO)
- **Authorized official phone:** (480) 421-8005

## Contact information

- **Practice address:** 1289 DEMING WAY, MADISON, WI 53717-2007
- **Practice address phone:** (800) 558-7046
- **Practice address fax:** (888) 898-7412
- **Mailing address:** 1289 DEMING WAY, MADISON, WI 53717-2007
- **Mailing address phone:** (800) 558-7046
- **Mailing address fax:** (888) 898-7412

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 9070-042 | WI | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 05/06/2011
- **Last updated:** 02/23/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2130190 | PK | — |