Provider Demographics
NPI:1376189407
Name:EDGERTON CHEMISTS INC.
Entity Type:Organization
Organization Name:EDGERTON CHEMISTS INC.
Other - Org Name:EDGERTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAIBABU
Authorized Official - Middle Name:
Authorized Official - Last Name:APPALANENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-884-3308
Mailing Address - Street 1:1011 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:WI
Mailing Address - Zip Code:53534-1325
Mailing Address - Country:US
Mailing Address - Phone:608-884-3308
Mailing Address - Fax:608-884-7725
Practice Address - Street 1:1011 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:WI
Practice Address - Zip Code:53534-1325
Practice Address - Country:US
Practice Address - Phone:608-884-3308
Practice Address - Fax:608-884-7725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100098751Medicaid