Wautoma Hometown Pharmacy
LBN: Wautoma Hometown Pharmacy Llc
Wautoma Hometown Pharmacy is an health care organization with primary practice located at W7810 State Road 21 Ste B , Wautoma WI 54982-7702. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Community/Retail Pharmacy, Suppliers / Specialty Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Wautoma Hometown Pharmacy Llc can be contacted via phone (920) 787-9561, or through Stocks, Haley via phone (920) 992-6800.
Contact Information
Primary practice address
W7810 State Road 21 Ste B
Wautoma WI 54982-7702
Phone: (920) 787-9561
Fax: (920) 787-9553
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Durable Medical Equipment & Medical Supplies | 332B00000X | ||
| Suppliers / Community/Retail Pharmacy | 3336C0003X | ||
| Suppliers / Specialty Pharmacy | 3336S0011X |
Profile Details
| NPI number | 1174187827 |
|---|---|
| LBN Legal business name | Wautoma Hometown Pharmacy Llc |
| DBA Doing business as | Wautoma Hometown Pharmacy |
| Authorized official | Stocks, Haley CPHT |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Apr 29th, 2019 |
| Last updated | May 12th, 2022 - about 2 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1174187827 | NPPES |
| Wisconsin | MEDICAID | 100088330 |
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