Organization
PAMIDA STORES OPERATING CO LLC
Active
Other names
Pamida Pharmacy 108
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN HARLOW (CEO/PRESIDENT)
(402) 596-7206
Entity
Organization
Contact information
Practice address
1011 E SPRUCE ST, ABBOTSFORD, WI 54405-9647
(715) 223-2480
(715) 223-2663
Mailing address
1011 E SPRUCE ST, ABBOTSFORD, WI 54405-9647
(715) 223-2480
(715) 223-2663
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8590042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33270500
—
WI
01
—
5127483
NCPDP NUMBER
—
Enumeration date
05/20/2006
Last updated
11/23/2009
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