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Organization
WEST SALEM PHARMACY LLC
Active
Organization
WEST SALEM PHARMACY LLC
Active
Other names
WEST SALEM PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
AMY BRIESKE (PHARMACY MGR)
(608) 786-0210
Entity
Organization
Contact information
Practice address
880 MILL ST N, WEST SALEM, WI 54669-2213
(608) 786-0210
(608) 786-0211
Mailing address
PO BOX 185, WEST SALEM, WI 54669-0185
(608) 786-0210
(608) 786-0211
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
9004-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2111878
PK
—
05
—
33287600
—
WI
Enumeration date
05/09/2006
Last updated
08/09/2016
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