# THEDACARE, INCORPORATED

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- **Entity:** Organization
- **Status:** Active
- **Other names:** THEDA CARE PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982707089
- **Authorized official:** TRINI SENZIG PHARMD (BUSINESS MANAGER)
- **Authorized official phone:** (715) 524-1464

## Contact information

- **Practice address:** 100 COUNTY ROAD B, SHAWANO, WI 54166-7072
- **Practice address phone:** (715) 526-3456
- **Practice address fax:** (715) 524-5627
- **Mailing address:** 100 COUNTY ROAD B, SHAWANO, WI 54166-7072
- **Mailing address phone:** (715) 526-3456
- **Mailing address fax:** (715) 524-5627

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 8673-42 | WI | Yes |

## Other

- **Enumeration date:** 09/06/2006
- **Last updated:** 03/29/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2114258 | PK | — |
| 05 | — | 33239800 | — | WI |