Organization
H1 LACROSSE LLC
Active
Other names
Uvanta Pharmacy of LaCrosse
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF VANSTRATEN (OWNER)
(262) 347-9405
Entity
Organization
Contact information
Practice address
2840 21ST PL S, LA CROSSE, WI 54601-7302
(608) 784-6500
(608) 784-6504
Mailing address
2840 21ST PL S, LA CROSSE, WI 54601-7302
(608) 784-6500
(608) 784-6504
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
8750042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33299800
—
WI
01
—
5130024
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/12/2007
Last updated
08/09/2011
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