Organization
MAYER DRUG INC
Active
Other names
LARSEN MAYER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND LARSEN (PRESIDENT)
(262) 658-8124
Entity
Organization
Contact information
Practice address
3535 30TH AVE, STE 103, KENOSHA, WI 53144-1632
(262) 658-8124
(262) 564-8667
Mailing address
3535 30TH AVE, STE 103, KENOSHA, WI 53144-1632
(262) 658-8124
(262) 564-8667
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
8019-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3305290033069300
—
WI
01
—
5102392
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/23/2005
Last updated
10/06/2010
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