Organization
MOE DRUGS LLC
Active
Other names
Three Lakes Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SETH MOE (PHARMD)
(920) 639-1384
Entity
Organization
Contact information
Practice address
1790 SUPERIOR ST, THREE LAKES, WI 54562-9046
(715) 546-3266
(715) 546-2912
Mailing address
1790 SUPERIOR ST, THREE LAKES, WI 54562-9046
(715) 546-3266
(715) 546-2912
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9400-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100055480
—
WI
01
—
2158870
PK
—
Enumeration date
02/22/2016
Last updated
02/20/2017
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