Organization
THEDACARE, INCORPORATED
Active
Other names
THEDA CARE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
TRINI SENZIG PHARMD (BUSINESS MANAGER)
(715) 524-1464
Entity
Organization
Contact information
Practice address
100 COUNTY ROAD B, SHAWANO, WI 54166-7072
(715) 526-3456
(715) 524-5627
Mailing address
100 COUNTY ROAD B, SHAWANO, WI 54166-7072
(715) 526-3456
(715) 524-5627
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8673-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2114258
PK
—
05
—
33239800
—
WI
Enumeration date
09/06/2006
Last updated
03/29/2016
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