Provider Demographics
NPI:1437334109
Name:BOBROWSKI INDUSTRIES CO
Entity Type:Organization
Organization Name:BOBROWSKI INDUSTRIES CO
Other - Org Name:SOMERSET DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-247-3535
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:WI
Mailing Address - Zip Code:54025-0250
Mailing Address - Country:US
Mailing Address - Phone:715-247-3535
Mailing Address - Fax:715-247-3636
Practice Address - Street 1:107 PARENT ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:WI
Practice Address - Zip Code:54025-7439
Practice Address - Country:US
Practice Address - Phone:715-247-3535
Practice Address - Fax:715-247-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9307423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152495OtherPK
2111084OtherPK
WI36226500Medicaid