Organization
JERRYS ENTERPRISES INC
Active
Other names
COUNTY MARKET PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JOYCE LARSON R.PH. (CONTROLLER)
(952) 928-1698
Entity
Organization
Contact information
Practice address
2310 CREST VIEW DR, HUDSON, WI 54016-9315
(715) 381-5923
(715) 381-5993
Mailing address
2310 CREST VIEW DR, HUDSON, WI 54016-9315
(715) 381-5923
(715) 381-5993
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8363-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2108748
PK
—
05
—
33272100
—
WI
Enumeration date
09/30/2006
Last updated
02/20/2017
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