Organization
PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS W JOHNSON RPH (REIMBURSEMENT MANAGER)
(262) 928-4704
Entity
Organization
Contact information
Practice address
791 SUMMIT AVE, OCONOMOWOC, WI 53066-3844
(262) 569-0471
(262) 569-0422
Mailing address
791 SUMMIT AVE, OCONOMOWOC, WI 53066-3844
(262) 569-0471
(262) 569-0422
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
4758042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5108510
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/30/2006
Last updated
12/14/2022
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