Organization
PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL, INC.
Active
Other names
ProHealth Pharmacy - Oconomowoc
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS JOHNSON (REIMBURSEMENT MANAGER)
(262) 928-4704
Entity
Organization
Contact information
Practice address
791 SUMMIT AVE STE 1106, OCONOMOWOC, WI 53066-3844
(262) 569-0284
(262) 569-0539
Mailing address
791 SUMMIT AVE, OCONOMOWOC, WI 53066-3844
(262) 569-0284
(262) 569-0539
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
8772
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2111058
PK
—
Enumeration date
09/26/2007
Last updated
12/14/2022
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