Organization
RIVER PRAIRIE PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT JOSEPH DEFATTA MD (OWNER)
(715) 828-2368
Entity
Organization
Contact information
Practice address
1490 RIVERS EDGE TRL, ALTOONA, WI 54720-2755
(715) 828-2368
(715) 839-7796
Mailing address
1490 RIVERS EDGE TRL, ALTOONA, WI 54720-2755
(715) 828-2368
(715) 839-7796
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Enumeration date
04/20/2021
Last updated
04/20/2021
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