Organization
WATERLOO HOMETOWN PHARMACY LLC
Active
Other names
WATERLOO HOMETOWN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE DEANS (CONTRACTING)
(920) 992-6800
Entity
Organization
Contact information
Practice address
806 N MONROE ST, WATERLOO, WI 53594-1135
(920) 478-8273
(920) 478-8274
Mailing address
333 LOWVILLE RD, RIO, WI 53960-9437
(920) 992-6800
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9505
WI
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2177494
PK
—
Enumeration date
03/21/2018
Last updated
05/04/2018
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