Organization
E.A. MCCULLOUGH, INC.
Active
Other names
McCullough's Prescriptions and Gifts
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES EDWARD MCCULLOUGH RPH (PRESIDENT)
(262) 248-6226
Entity
Organization
Contact information
Practice address
269 BROAD ST, LAKE GENEVA, WI 53147-1809
(262) 248-6226
Mailing address
694 S WELLS ST, LAKE GENEVA, WI 53147-2106
(262) 248-8582
(262) 248-8593
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
4700
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33108300
—
WI
Enumeration date
08/29/2006
Last updated
02/04/2008
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