# MAYER DRUG INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LARSEN MAYER PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790778967
- **Authorized official:** RAYMOND LARSEN (PRESIDENT)
- **Authorized official phone:** (262) 658-8124

## Contact information

- **Practice address:** 3535 30TH AVE, STE 103, KENOSHA, WI 53144-1632
- **Practice address phone:** (262) 658-8124
- **Practice address fax:** (262) 564-8667
- **Mailing address:** 3535 30TH AVE, STE 103, KENOSHA, WI 53144-1632
- **Mailing address phone:** (262) 658-8124
- **Mailing address fax:** (262) 564-8667

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 8019-42 | WI | Yes |

## Other

- **Enumeration date:** 08/23/2005
- **Last updated:** 10/06/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3305290033069300 | — | WI |
| 01 | — | 5102392 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |