Organization
KEWAUNEE HOMETOWN PHARMACY LLC
Active
Other names
KEWAUNEE HOMETOWN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE HERMANSEN (CONTRACTING SPECIALIST)
(920) 992-6800
Entity
Organization
Contact information
Practice address
1614 CENTER ST, KEWAUNEE, WI 54216-1792
(920) 310-1616
(920) 388-6164
Mailing address
333 LOWVILLE RD, RIO, WI 53960-9437
(920) 992-6800
(920) 992-6801
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100090741
—
WI
Enumeration date
06/14/2019
Last updated
07/25/2025
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