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Organization

STOCKBRIDGE MUNSEE COMMUNITY

Active
Other names
Stockbridge Munsee Health & Wellness
Organization subpart
No

Provider details

NPI number
Authorized official
ROBERT CHICKS (PRESIDENT)
(715) 793-4111
Entity
Organization

Contact information

Practice address
W12802 COUNTY ROAD A, BOWLER, WI 54416-0086
(715) 793-4144
(715) 793-4120
Mailing address
W12802 COUNTY ROAD A, BOWLER, WI 54416-0086
(715) 793-4144
(715) 793-4120

Taxonomy

Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
33021000
WI
01
5118799
NCPDC-PHARMACY
WI
Enumeration date
03/08/2007
Last updated
12/04/2008
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