Organization
MD GROUP LLC
Active
Other names
DeForest Hometown Pharmacy LTC
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE DEANS (CONTRACTING MANAGER)
(920) 992-6800
Entity
Organization
Contact information
Practice address
645 S MAIN ST, DEFOREST, WI 53532-1421
(608) 846-4736
(608) 846-6892
Mailing address
333 LOWVILLE RD, RIO, WI 53960-9437
(920) 992-6800
(920) 614-6100
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33266300
—
WI
Enumeration date
07/30/2026
Last updated
07/30/2026
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