Organization
MOUNT HOREB FAMILY PHARMACY LLC
Active
Other names
Mount Horeb Family Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER WEILAND (OWNER)
(608) 437-3001
Entity
Organization
Contact information
Practice address
203 W MAIN ST, MOUNT HOREB, WI 53572-1914
(608) 437-3001
(608) 437-6480
Mailing address
203 W MAIN ST, MOUNT HOREB, WI 53572-1914
(608) 437-3001
(608) 437-6480
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
835442
WI
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2112892
PK
—
05
—
33271700
—
WI
01
—
K300846024
MEDICARE PTAN
—
Enumeration date
09/21/2006
Last updated
05/05/2022
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