# SHELL LAKE PHARMACY LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962920926
- **Authorized official:** PAIGE WILES (ADMINISTRATIVE ASSISTANT)
- **Authorized official phone:** (715) 418-3478

## Contact information

- **Practice address:** 113 4TH AVE, SHELL LAKE, WI 54871-4457
- **Practice address phone:** (715) 468-7800
- **Mailing address:** PO BOX 343, SHELL LAKE, WI 54871-0343

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 08/30/2017
- **Last updated:** 02/03/2020