Provider Demographics
NPI:1164170692
Name:5 GUYSRX 3 LLC
Entity Type:Organization
Organization Name:5 GUYSRX 3 LLC
Other - Org Name:WELLCREEK PHARMACY MIDDLETON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ZIETLOW
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:608-203-8090
Mailing Address - Street 1:2532 ALLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-2212
Mailing Address - Country:US
Mailing Address - Phone:608-203-8090
Mailing Address - Fax:608-203-8155
Practice Address - Street 1:2532 ALLEN BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-2212
Practice Address - Country:US
Practice Address - Phone:608-345-0330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy