Organization
JERRYS ENTERPRISES INC
Active
Other names
COUNTY MARKET PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH HOEHN RPH (PHARMACY MANAGER)
(715) 218-3925
Entity
Organization
Contact information
Practice address
220 S 18TH AVE, WAUSAU, WI 54401-4252
(715) 842-3541
(715) 845-5306
Mailing address
220 S 18TH AVE, WAUSAU, WI 54401-4252
(715) 842-3541
(715) 845-5306
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8362042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2113198
PK
—
05
—
33271600
—
WI
Enumeration date
08/18/2006
Last updated
11/24/2020
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