Organization
FOX VALLEY HEMATOLOGY & ONCOLOGY S C
Active
Other names
Fox Valley Family Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY GOGGINS (CHIEF MEDICAL OFFICER/PHYSICIAN)
(920) 749-1171
Entity
Organization
Contact information
Practice address
3925 N GATEWAY DR, SUITE 100, APPLETON, WI 54913-7863
(920) 702-4802
(920) 702-4319
Mailing address
3232 N BALLARD RD, SUITE 200, APPLETON, WI 54911-8804
(920) 749-9668
(920) 734-5307
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9433-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2167333
PK
—
Enumeration date
01/19/2017
Last updated
05/08/2017
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