Organization
COMMUNITY PHARMACY CO-OPERATIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AIMEE SPEERS PHARM D (PHARMACIST IN CHARGE)
(608) 251-4454
Entity
Organization
Contact information
Practice address
130 FAIROAKS AVE, MADISON, WI 53704
(608) 251-4454
(608) 251-3853
Mailing address
130 FAIROAKS AVE., MADISON, WI 53704
(608) 251-4454
(608) 251-3853
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
6464
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699793380
—
WI
05
—
33134900
—
WI
01
—
480001188
MEDCO PAID
—
Enumeration date
07/18/2006
Last updated
08/24/2021
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