Organization
LAKE MILLS HOMETOWN PHARMACY LLC
Active
Other names
LAKE MILLS HOMETOWN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL STRAUSE (CEO)
(920) 992-6800
Entity
Organization
Contact information
Practice address
372 E TYRANENA PARK RD, LAKE MILLS, WI 53551-9680
(920) 945-2500
(920) 945-2503
Mailing address
333 LOWVILLE RD, RIO, WI 53960-9437
(920) 992-6800
(920) 992-6801
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9469-42
WI
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100070330
—
WI
Enumeration date
06/26/2017
Last updated
06/24/2020
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