Organization
VILLAGE APOTHECARY INC
Active
Other names
THE VILLAGE APOTHECARY
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD GUSSICK RPH (PRESIDENT)
(920) 533-4012
Entity
Organization
Contact information
Practice address
110 W MAIN ST, CAMPBELLSPORT, WI 53010-2704
(920) 533-4012
(920) 533-4012
Mailing address
110 W MAIN ST, CAMPBELLSPORT, WI 53010-2704
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5998042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33008900
—
WI
01
—
5113636
OTHER ID NUMBER
—
Enumeration date
02/02/2007
Last updated
09/12/2007
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