Organization
BADGER PHARMACY LLC
Active
Other names
Young's Drug Store
Organization subpart
No
Provider details
NPI number
Authorized official
FORREST YOUNG RPH (OWNER)
(715) 842-0370
Entity
Organization
Contact information
Practice address
310 E BRIDGE ST, WAUSAU, WI 54403-3589
(715) 845-5203
(715) 843-0883
Mailing address
555 S 72ND AVE, WAUSAU, WI 54401-9038
(715) 842-0370
(715) 842-0366
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8995-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073628020
—
WI
01
—
5113600
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/20/2006
Last updated
08/04/2014
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