Organization
GWIDT PHARMACY INC
Active
Other names
Gwidt Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE RESCH (VICE-PRESIDENT)
(715) 253-2164
Entity
Organization
Contact information
Practice address
203 E WESTGOR AVE, SUITE 1, WITTENBERG, WI 54499-9174
(715) 253-2164
(715) 253-3030
Mailing address
PO BOX 253, WITTENBERG, WI 54499-0253
(715) 253-2164
(715) 253-3030
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
8989-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2123642
PK
—
Enumeration date
01/15/2010
Last updated
08/12/2016
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