# MCCULLOUGH PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MCCULLOUGHS PRESCRIPTION AND GIFTS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881703676
- **Authorized official:** JAMES MCCULLOUGH (PRESIDENT)
- **Authorized official phone:** (262) 248-8582

## Contact information

- **Practice address:** 547 KENOSHA ST, WALWORTH, WI 53184-9512
- **Practice address phone:** (262) 275-2137
- **Practice address fax:** (262) 275-5743
- **Mailing address:** 547 KENOSHA ST, WALWORTH, WI 53184-9512

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 5931042 | WI | Yes |

## Other

- **Enumeration date:** 08/29/2006
- **Last updated:** 09/13/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 33086500 | — | WI |
| 01 | — | 5110022 | OTHER ID NUMBER | — |