Provider Demographics
NPI:1477680213
Name:ASHLAND PHARMACY INC
Entity Type:Organization
Organization Name:ASHLAND PHARMACY INC
Other - Org Name:DBA: HUHN RX DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:PECHACEK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:715-762-3283
Mailing Address - Street 1:522 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806
Mailing Address - Country:US
Mailing Address - Phone:715-682-3123
Mailing Address - Fax:715-682-6494
Practice Address - Street 1:522 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806
Practice Address - Country:US
Practice Address - Phone:715-682-3123
Practice Address - Fax:715-682-6494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WI71620423336C0003X
WI9031-423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33179900Medicaid
5120679OtherOTHER ID NUMBER-COMMERCIAL NUMBER
5120679OtherOTHER ID NUMBER
6491670001Medicare NSC