Organization
GWIDT PHARMACY INC
Active
Other names
OCONTO FALLS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY STARRY B.S. PHARM (PRESIDENT)
(920) 848-3721
Entity
Organization
Contact information
Practice address
323 E HIGHLAND DR, OCONTO FALLS, WI 54154-1006
(920) 848-3721
(920) 848-4374
Mailing address
PO BOX 129, OCONTO FALLS, WI 54154-0129
(920) 848-3721
(920) 848-4374
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
7999-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2112905
PK
—
05
—
33213600
—
WI
Enumeration date
11/03/2006
Last updated
05/01/2017
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