Organization
FORUM EXTENDED CARE SERVICES OF WISCONSIN INC
Active
Other names
Willow Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN KRAMER (PRESIDENT)
(847) 673-8727
Entity
Organization
Contact information
Practice address
2445 DARWIN RD, SUITE 102, MADISON, WI 53704-3116
(608) 240-2280
(608) 240-2288
Mailing address
4201 W VICTORIA ST, CHICAGO, IL 60646-6700
(847) 673-8727
(847) 673-6215
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
9417-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100001648
—
WI
01
—
2117872
PK
—
Enumeration date
10/16/2008
Last updated
03/22/2022
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