Provider Demographics
NPI:1437397577
Name:LADYSMITH FOODS INC.
Entity Type:Organization
Organization Name:LADYSMITH FOODS INC.
Other - Org Name:FLAMBEAU PHAMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:E
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PRX
Authorized Official - Phone:715-532-6614
Mailing Address - Street 1:400 W 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:LADYSMITH
Mailing Address - State:WI
Mailing Address - Zip Code:54848-1249
Mailing Address - Country:US
Mailing Address - Phone:715-532-6614
Mailing Address - Fax:715-532-9293
Practice Address - Street 1:400 W 9TH ST N
Practice Address - Street 2:
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-1249
Practice Address - Country:US
Practice Address - Phone:715-532-6614
Practice Address - Fax:715-532-9293
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LADYSMITH FOODS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-28
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8918-042333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy