Organization
BOSCOBEL PHARMACY, INC
Active
Other names
Bohlman Drug Store, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELLE E. FARRELL PHARMD (PHARMACIST, OWNER)
(608) 375-4466
Entity
Organization
Contact information
Practice address
1028 WISCONSIN AVE, BOSCOBEL, WI 53805-1532
(608) 375-4466
(608) 375-2383
Mailing address
1028 WISCONSIN AVE, BOSCOBEL, WI 53805-1532
(608) 375-4466
(608) 375-2383
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
6474-042
WI
332BX2000X
Oxygen Equipment & Supplies (DME)
6474-042
WI
3336C0003X
Community/Retail Pharmacy
Primary
6474-042
WI
3336H0001X
Home Infusion Therapy Pharmacy
6474-042
WI
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33051200
—
WI
01
—
5105312
NCPDP
WI
Enumeration date
08/05/2006
Last updated
02/17/2020
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