Organization
CEDAR LAKE PHARMACY
Active
Organization
CEDAR LAKE PHARMACY
Active
Other names
CEDAR LAKE PAHRMACY-DME
Organization subpart
No
Provider details
NPI number
Authorized official
CHRIS CHERNEY (CFO)
(262) 306-4212
Entity
Organization
Contact information
Practice address
5595 COUNTY ROAD Z, WEST BEND, WI 53095-9224
(262) 306-2117
(262) 306-2126
Mailing address
5595 COUNTY ROAD Z, WEST BEND, WI 53095-9224
(262) 306-2117
(262) 306-2126
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
5115503
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20125800
—
WI
Enumeration date
03/23/2007
Last updated
08/22/2020
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