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Organization
WATERLOO HOMETOWN PHARMACY LLC
Active
Organization
WATERLOO HOMETOWN PHARMACY LLC
Active
Other names
WATERLOO HOMETOWN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE DEANS (CONTRACTING)
(920) 992-6800
Entity
Organization
Contact information
Practice address
806 N MONROE ST, WATERLOO, WI 53594-1135
(920) 478-8273
(920) 478-8274
Mailing address
333 LOWVILLE RD, RIO, WI 53960-9437
(920) 992-6800
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
9505
WI
3336S0011X
Specialty Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2177494
PK
—
Enumeration date
03/21/2018
Last updated
05/04/2018
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