Organization
LADD MEMORIAL HOSPITAL
Active
Other names
Osceola Clinic Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MATT FORGE (CHIEF EXECUTIVE OFFICER)
(715) 294-5622
Entity
Organization
Contact information
Practice address
2600 65TH AVENUE, OSCEOLA, WI 54020-0218
(715) 294-4050
(715) 294-5690
Mailing address
PO BOX 218, OSCEOLA, WI 54020-0218
(715) 294-4050
(715) 294-5690
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
9071-042
WI
Other
Enumeration date
05/04/2011
Last updated
01/10/2020
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