Organization
BADGER ACQUISITION OF WISCONSIN, LLC
Active
Other names
Luther Haven Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN D KUKULSKI (CORPORATE SECRETARY)
(513) 719-2600
Entity
Organization
Contact information
Practice address
8949 N 97TH ST, MILWAUKEE, WI 53224-1695
(414) 354-8554
(414) 354-8521
Mailing address
201 E 4TH ST, 900 OMNICARE CENTER, CINCINNATI, OH 45202-4248
(513) 719-2600
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
032006914
WI
3336L0003X
Long Term Care Pharmacy
Primary
032006914
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33232400
—
WI
01
—
5119145
NCPDP
WI
Enumeration date
09/15/2006
Last updated
09/15/2014
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