Organization
MEDICAL PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT BUTH (PRES)
(202) 251-8500
Entity
Organization
Contact information
Practice address
N84W16889 MENOMONEE AVE, MENOMONEE FALLS, WI 53051-2810
(262) 251-8500
(262) 251-8994
Mailing address
N84W16889 MENOMONEE AVE, MENOMONEE FALLS, WI 53051-2810
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
7460042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33132000
—
WI
01
—
5102253
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/21/2006
Last updated
02/01/2008
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