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Organization
MD GROUP LLC
Active
Organization
MD GROUP LLC
Active
Other names
DeForest Hometown Pharmacy LTC
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE DEANS (CONTRACTING MANAGER)
(920) 992-6800
Entity
Organization
Contact information
Practice address
645 S MAIN ST, DEFOREST, WI 53532-1421
(608) 846-4736
(608) 846-6892
Mailing address
333 LOWVILLE RD, RIO, WI 53960-9437
(920) 992-6800
(920) 614-6100
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33266300
—
WI
Enumeration date
07/30/2026
Last updated
07/30/2026
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