Organization
PHILLIPS DRUG STORE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE MACARDY R PH (PRESIDENT)
(608) 847-5949
Entity
Organization
Contact information
Practice address
123 E STATE ST, MAUSTON, WI 53948
(608) 847-5949
(608) 847-5004
Mailing address
PO BOX 136, MAUSTON, WI 53948-0136
(608) 847-5949
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
5621042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33095800
—
WI
Enumeration date
02/02/2006
Last updated
02/09/2011
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