Organization
IV COMPOUND CENTER OF WISCONSIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD STEVEN KOSHAK RPH (OWNER)
(262) 641-2850
Entity
Organization
Contact information
Practice address
5478 S WESTRIDGE DR, NEW BERLIN, WI 53151-7948
(262) 641-2850
(262) 641-2854
Mailing address
5478 S WESTRIDGE DR, NEW BERLIN, WI 53151-7948
(262) 641-2850
(262) 641-2854
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
8543-042
WI
Other
Enumeration date
03/30/2013
Last updated
03/30/2013
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