# WAUWATOSA PRESCRIPTION CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Skywalk Mequon
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811344666
- **Authorized official:** JACOB OLSON RPH (PRESIDENT/CEO/AO/PIC)
- **Authorized official phone:** (262) 432-7603

## Contact information

- **Practice address:** 1655 W MEQUON RD, MEQUON, WI 53092
- **Practice address phone:** (262) 236-7722
- **Practice address fax:** (262) 236-7784
- **Mailing address:** 1655 W MEQUON RD, MEQUON, WI 53092
- **Mailing address phone:** (262) 236-7722
- **Mailing address fax:** (262) 236-7784

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 9271-42 | WI | Yes |

## Other

- **Enumeration date:** 05/23/2016
- **Last updated:** 08/03/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100038951 | — | WI |
| 01 | — | 2160228 | PK | — |