# MEDFORD PHARMACY INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1811201742
- **Authorized official:** PAIGE WILES (ADMIN ASSISTANT)
- **Authorized official phone:** (715) 418-3478

## Contact information

- **Practice address:** 210 S MAIN ST, MEDFORD, WI 54451-1843
- **Practice address phone:** (715) 748-4477
- **Practice address fax:** (715) 748-5848
- **Mailing address:** 210 S MAIN ST, MEDFORD, WI 54451-1843
- **Mailing address phone:** (715) 748-4477
- **Mailing address fax:** (715) 748-5848

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 9018-42 | WI | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 08/03/2010
- **Last updated:** 10/04/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 5132319 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |