Organization
FOND DU LAC PRESCRIPTION CENTER, LTD
Active
Other names
Consumer Prescription Center
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT A. GRINNELL RPH (PRESIDENT)
(920) 923-1260
Entity
Organization
Contact information
Practice address
52 SHEBOYGAN ST, FOND DU LAC, WI 54935-4220
(920) 923-1260
Mailing address
52 SHEBOYGAN ST, FOND DU LAC, WI 54935-4220
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
5390
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33135600
—
WI
Enumeration date
08/31/2006
Last updated
08/22/2020
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