Organization
MEQUON FAMILY PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA MUGURDUMOVA (CEO)
(262) 581-0411
Entity
Organization
Contact information
Practice address
1424 W MEQUON RD, MEQUON, WI 53092-3226
(262) 581-0411
(262) 923-1002
Mailing address
1424 W MEQUON RD, MEQUON, WI 53092-3226
(262) 581-0411
(262) 923-1002
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2168769
PK
—
Enumeration date
02/28/2017
Last updated
04/11/2017
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