Organization
SHELL LAKE PHARMACY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAIGE WILES (ADMIN ASSISTANT)
(715) 418-3478
Entity
Organization
Contact information
Practice address
113 4TH AVE, SHELL LAKE, WI 54871-4457
(715) 468-7800
(715) 468-7921
Mailing address
PO BOX 343, SHELL LAKE, WI 54871-0343
(715) 468-7800
(715) 468-7921
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
6461042
WI
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33038100
—
WI
Enumeration date
11/14/2006
Last updated
10/04/2024
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