Organization
SOURCE ONE HEALTHCARE A DIVISION OF PHILLIPS PHARMACIES
Active
Parent organization
PHILLIPS DRUG STORE INC.
Other names
Sourceone Healthcare
Organization subpart
Yes
Provider details
NPI number
Legal business name
PHILLIPS DRUG STORE INC.
Authorized official
WAYNE MACARDY (PRESIDENT)
(800) 779-1276
Entity
Organization
Contact information
Practice address
123 E STATE ST, MAUSTON, WI 53948-1344
(800) 779-1276
(608) 847-5739
Mailing address
123 E STATE ST, P.O. BOX 218, MAUSTON, WI 53948-1344
(800) 779-1276
(608) 847-5739
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
12/12/2006
Last updated
11/13/2007
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