# DEN DIA IV

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- **Entity:** Organization
- **Status:** Active
- **Other names:** STOWE DRUG STORE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932328242
- **Authorized official:** DENNIS LARSON RPH (PRESIDENT AND PHARMACIST)
- **Authorized official phone:** (920) 336-6128

## Contact information

- **Practice address:** 375 MAIN AVE, DE PERE, WI 54115-2202
- **Practice address phone:** (920) 336-6128
- **Mailing address:** 375 MAIN AVE, DE PERE, WI 54115-2202

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 6162042 | WI | Yes |

## Other

- **Enumeration date:** 04/25/2007
- **Last updated:** 09/12/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 33055200 | — | WI |
| 01 | — | 5103332 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |