# WAUSAUKEE PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wausaukee HealthMart Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790013076
- **Authorized official:** MR. JEFFREY D HINES RPH (OWNER)
- **Authorized official phone:** (715) 856-5455

## Contact information

- **Practice address:** 703 MAIN ST, STE 2, WAUSAUKEE, WI 54177
- **Practice address phone:** (715) 856-5455
- **Practice address fax:** (715) 856-5451
- **Mailing address:** 703 MAIN ST, PO BOX 346, WAUSAUKEE, WI 54177
- **Mailing address phone:** (715) 856-5455
- **Mailing address fax:** (715) 856-5451

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 8961-042 | WI | Yes |

## Other

- **Enumeration date:** 11/25/2009
- **Last updated:** 11/25/2009