Organization
MANITOWOC PHARMACIES INC
Active
Other names
Health Mart Pulaski Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE RESCH (PRESIDENT)
(715) 253-2164
Entity
Organization
Contact information
Practice address
121 N SAINT AUGUSTINE ST, PULASKI, WI 54162-7982
(920) 822-3011
(920) 822-3852
Mailing address
121 N SAINT AUGUSTINE ST, PO BOX 200, PULASKI, WI 54162-7982
(920) 822-3011
(920) 822-3852
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
7901-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2134085
PK
—
05
—
33240600
—
WI
Enumeration date
08/20/2006
Last updated
08/12/2016
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