Organization
PHARMACY COMPOUNDING CENTER ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS BRIESKE (OWNER)
(608) 386-9039
Entity
Organization
Contact information
Practice address
1907 WEST AVE S, LA CROSSE, WI 54601-6206
(608) 788-4500
(608) 788-4501
Mailing address
PO BOX 185, WEST SALEM, WI 54669-0185
(608) 386-9039
(608) 788-4501
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
943642
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
943642
WISCONSIN PHARMACY LIC
WI
Enumeration date
12/06/2016
Last updated
12/06/2016
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