Organization
KCJE FORD INC
Active
Other names
MedPak Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTY BASSEUNER (PHARMACY TECHNICIAN)
(608) 784-9922
Entity
Organization
Contact information
Practice address
505 KING ST STE 154, LA CROSSE, WI 54601-4062
(608) 782-4448
(608) 782-4449
Mailing address
PO BOX 2496, LA CROSSE, WI 54602-2496
(608) 782-4448
(608) 782-4449
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
9122-042
WI
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100007292
—
WI
01
—
2122806
PK
—
Enumeration date
11/30/2009
Last updated
08/11/2016
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