Organization
BELLICOSE INTERNATIONAL INC.
Active
Other names
Wood River Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SELMA DZELIL PHARMD (VP RDO)
(815) 715-8502
Entity
Organization
Contact information
Practice address
122 W MADISON AVE, GRANTSBURG, WI 54840-7022
(715) 463-2525
(715) 463-5343
Mailing address
122 W MADISON AVE, GRANTSBURG, WI 54840-7022
(715) 463-2525
(715) 463-5343
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
6872
WI
333600000X
Pharmacy
Primary
6872
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000086607
MEDICARE
WI
05
—
33154200
—
WI
01
—
5106047
NABP
WI
Enumeration date
06/14/2005
Last updated
09/25/2023
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