Organization
PORT FAMILY PHARMACY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL J VINEBURG PHARMD. (OWNER)
(262) 261-3900
Entity
Organization
Contact information
Practice address
1021 N WISCONSIN ST, PORT WASHINGTON, WI 53074-1207
(262) 261-3900
Mailing address
1021 N WISCONSIN ST, PORT WASHINGTON, WI 53074-1207
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100216135
—
WI
Enumeration date
06/08/2022
Last updated
05/04/2023
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