Organization
WHITEFISH BAY PRESCRIPTION CENTER LTD
Active
Other names
Ye Olde Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN STEPHEN WACLAWSKI RPH (PRESIDENT)
(414) 963-0811
Entity
Organization
Contact information
Practice address
5320 N PORT WASHINGTON RD, GLENDALE, WI 53217
(414) 963-0811
(414) 963-0830
Mailing address
5320 N PORT WASHINGTON RD, GLENDALE, WI 53217
(414) 963-0811
(414) 963-0830
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
8527
WI
3336C0003X
Community/Retail Pharmacy
Primary
7296
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33002200
—
WI
Enumeration date
08/04/2006
Last updated
10/24/2008
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