Organization
KCJE FORD INC
Active
Other names
Cass Street Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH FORD RPH (OWNER)
(608) 784-9922
Entity
Organization
Contact information
Practice address
528 CASS ST, LA CROSSE, WI 54601-4507
(608) 784-9922
(608) 784-2212
Mailing address
528 CASS ST, LA CROSSE, WI 54601-4507
(608) 784-9922
(608) 784-2212
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
8293-42
WI
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2115062
PK
—
05
—
33165900
—
WI
05
—
395760800
—
MN
Enumeration date
07/26/2006
Last updated
05/10/2016
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