Organization
VILLAGE BAKE SHOP INC
Active
Other names
QUILLINS MAJOR DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES BERG RPH (HEAD PHARMACIST)
(608) 784-6200
Entity
Organization
Contact information
Practice address
3954 MORMON COULEE RD, LA CROSSE, WI 54601-7916
(608) 784-6200
(608) 784-3808
Mailing address
3954 MORMON COULEE RD, LA CROSSE, WI 54601-7916
(608) 784-6200
(608) 784-3808
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
7708-42
WI
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33060500
—
WI
01
—
5104687
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
636560400
—
MN
Enumeration date
09/30/2006
Last updated
05/19/2010
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