Organization
WAUWATOSA PRESCRIPTION CENTER INC
Active
Other names
Skywalk Mequon
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB OLSON RPH (PRESIDENT/CEO/AO/PIC)
(262) 432-7603
Entity
Organization
Contact information
Practice address
1655 W MEQUON RD, MEQUON, WI 53092
(262) 236-7722
(262) 236-7784
Mailing address
1655 W MEQUON RD, MEQUON, WI 53092
(262) 236-7722
(262) 236-7784
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9271-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100038951
—
WI
01
—
2160228
PK
—
Enumeration date
05/23/2016
Last updated
08/03/2016
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