Organization
13TH STREET PHARMACY LLC
Active
Other names
13th Street Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSEL SHTIVELBERG (MEMBER)
(414) 324-9393
Entity
Organization
Contact information
Practice address
1320 W BURNHAM ST, MILWAUKEE, WI 53204-3248
(414) 383-4111
(414) 383-2248
Mailing address
1320 W BURNHAM ST, MILWAUKEE, WI 53204-3248
(414) 383-4111
(414) 383-2248
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
9131-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100023902
—
WI
01
—
2135508
PK
—
Enumeration date
06/08/2012
Last updated
12/03/2014
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