Organization
KEALEY PHARMACY & HOME CARE CENTER
Active
Other names
KEALEY PHARMACY AND HOMECARE INC
Organization subpart
No
Provider details
NPI number
Authorized official
MARK JOHNSON RPH (OWNER / PRESIDENT)
(608) 752-7869
Entity
Organization
Contact information
Practice address
21 S JACKSON ST, JANESVILLE, WI 53548-3859
(608) 752-7869
(608) 752-6806
Mailing address
PO BOX 8005, JANESVILLE, WI 53547-8005
(608) 752-7869
(608) 752-6806
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
7301-042
WI
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2111847
PK
—
05
—
33117200
—
WI
Enumeration date
03/15/2007
Last updated
06/14/2013
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