Provider Demographics
NPI:1194854422
Name:HOTEL PHARMACY
Entity Type:Organization
Organization Name:HOTEL PHARMACY
Other - Org Name:BRADY STREET PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEARLES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:414-272-4384
Mailing Address - Street 1:1696 N ASTOR ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2164
Mailing Address - Country:US
Mailing Address - Phone:414-272-4384
Mailing Address - Fax:414-278-8724
Practice Address - Street 1:1696 N ASTOR ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2164
Practice Address - Country:US
Practice Address - Phone:414-272-4384
Practice Address - Fax:414-278-8724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI65513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5107708OtherNATIONAL PHARMQCY #
WI33141100Medicaid
WI5107708OtherNATIONAL PHARMQCY #