Organization
LAKE COUNTRY PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY JO HOUSTON RPH (PHARMACIST)
(262) 569-0284
Entity
Organization
Contact information
Practice address
791 SUMMIT AVE, OCONOMOWOC, WI 53066-3844
(262) 569-0284
(262) 569-0539
Mailing address
791 SUMMIT AVE, OCONOMOWOC, WI 53066-3844
(262) 569-0284
(262) 569-0539
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
6944
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33161400
—
WI
01
—
5119549
NABP
—
Enumeration date
10/07/2005
Last updated
08/22/2020
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