Organization
GWIDT PHARMACY INC
Active
Other names
GWIDT PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE RESCH (PRESIDENT)
(715) 253-2164
Entity
Organization
Contact information
Practice address
203 E WESTGOR AVE, WITTENBERG, WI 54499-9174
(715) 253-2164
(715) 253-3030
Mailing address
PO BOX 253, WITTENBERG, WI 54499-0253
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8440042
WI
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2113260
PK
—
05
—
33102800
—
WI
Enumeration date
07/30/2006
Last updated
08/01/2025
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