Provider Demographics
NPI:1326145152
Name:ELKHORN PHARMACY LTD
Entity Type:Organization
Organization Name:ELKHORN PHARMACY LTD
Other - Org Name:PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAY
Authorized Official - Middle Name:HERNING
Authorized Official - Last Name:KUE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:262-723-8444
Mailing Address - Street 1:603 EAST GENEVA STREET
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121
Mailing Address - Country:US
Mailing Address - Phone:262-723-8444
Mailing Address - Fax:262-723-8760
Practice Address - Street 1:603 E GENEVA ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-2301
Practice Address - Country:US
Practice Address - Phone:262-723-8444
Practice Address - Fax:262-723-8760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33199000Medicaid
0837890001Medicare ID - Type Unspecified