Larsen Mayer Pharmacy

LBN: Mayer Drug Inc
Larsen Mayer Pharmacy is an health care organization with primary practice located at 3535 30Th Ave Ste 103, Kenosha WI 53144-1632. The organization recently has only one registered license in Suppliers / Community/Retail Pharmacy, which is considered as the primary health care specialty. Mayer Drug Inc can be contacted via phone (262) 658-8124, or through Larsen, Raymond via phone (262) 658-8124.

Contact Information

Primary practice address
3535 30Th Ave Ste 103 Kenosha WI 53144-1632
Phone: (262) 658-8124
Fax: (262) 564-8667
Website:
Map and Directions
Authorized official contact:
Name: Larsen, Raymond
Phone: (262) 658-8124

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Community/Retail Pharmacy 3336C0003X 8019-42 Wisconsin

Profile Details

NPI number 1790778967
LBN Legal business name Mayer Drug Inc
DBA Doing business as Larsen Mayer Pharmacy
Authorized official Larsen, Raymond
Entity Organization
Organization subpart 1 No
Enumeration date Aug 23rd, 2005
Last updated Oct 6th, 2010 - about 15 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790778967 NPPES
Other 5102392 NCPDP PROVIDER IDENTIFICATION NUMBER
MEDICAID 3305290033069300 NCPDP PROVIDER IDENTIFICATION NUMBER

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