Provider Demographics
NPI:1003175266
Name:PHARMACY HOLDING COMPANY OF WISCONSIN LLC
Entity Type:Organization
Organization Name:PHARMACY HOLDING COMPANY OF WISCONSIN LLC
Other - Org Name:AMERICAS BEST PET PHARMACY/UNIVERSAL COMPOUNDERS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-358-4070
Mailing Address - Street 1:PO BOX 1968
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:WI
Mailing Address - Zip Code:54568-1968
Mailing Address - Country:US
Mailing Address - Phone:715-358-4070
Mailing Address - Fax:715-358-4072
Practice Address - Street 1:1256 OLD 51 S
Practice Address - Street 2:
Practice Address - City:ARBOR VITAE
Practice Address - State:WI
Practice Address - Zip Code:54568-9793
Practice Address - Country:US
Practice Address - Phone:715-358-4070
Practice Address - Fax:715-358-4072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11215/7.1333600000X
WI9082-0423336C0004X
FLPH259823336C0004X
NE6963336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5133169OtherNCPDP PROVIDER IDENTIFICATION NUMBER