Organization
MEDFORD PHARMACY INC
Active
Other names
MEDFORD PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
PAIGE WILES (ADMIN ASSISTANT)
(715) 418-3478
Entity
Organization
Contact information
Practice address
210 S MAIN ST, MEDFORD, WI 54451-1843
(715) 748-4477
(715) 748-5848
Mailing address
210 S MAIN ST, MEDFORD, WI 54451-1843
(715) 748-4477
(715) 748-5848
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9018-42
WI
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5132319
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/03/2010
Last updated
10/04/2024
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