Provider Demographics
NPI:1285045377
Name:TOMAHAWK PHARMACY LLC
Entity Type:Organization
Organization Name:TOMAHAWK PHARMACY LLC
Other - Org Name:TOMAHAWK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:715-453-6600
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-0429
Mailing Address - Country:US
Mailing Address - Phone:715-453-6600
Mailing Address - Fax:
Practice Address - Street 1:315 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487-1133
Practice Address - Country:US
Practice Address - Phone:715-453-6600
Practice Address - Fax:715-453-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
WI926442333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy