Organization
MCCULLOUGH PHARMACY INC
Active
Other names
MCCULLOUGHS PRESCRIPTION AND GIFTS
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES MCCULLOUGH (PRESIDENT)
(262) 248-8582
Entity
Organization
Contact information
Practice address
547 KENOSHA ST, WALWORTH, WI 53184-9512
(262) 275-2137
(262) 275-5743
Mailing address
547 KENOSHA ST, WALWORTH, WI 53184-9512
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5931042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33086500
—
WI
01
—
5110022
OTHER ID NUMBER
—
Enumeration date
08/29/2006
Last updated
09/13/2007
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