Organization
MC5 INC
Active
Other names
MCCULLOUGHS PRESCRIPTION AND GIFTS
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES MCCULLOUGH (VICE PRESIDENT)
(262) 248-8582
Entity
Organization
Contact information
Practice address
1173 W MAIN ST, WHITEWATER, WI 53190-1672
(262) 473-5065
(262) 473-7357
Mailing address
694 S WELLS ST, LAKE GENEVA, WI 53147-2106
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
6604042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33048100
—
WI
01
—
5115844
OTHER ID NUMBER
—
Enumeration date
08/29/2006
Last updated
12/09/2016
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