Provider Demographics
NPI:1487849055
Name:UNIVERSITY HLTH SERV PHARMACY
Entity Type:Organization
Organization Name:UNIVERSITY HLTH SERV PHARMACY
Other - Org Name:UW-STEVENS POINT HEALTH SERVICE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:HETTLER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:715-346-4646
Mailing Address - Street 1:910 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-3105
Mailing Address - Country:US
Mailing Address - Phone:715-346-4646
Mailing Address - Fax:715-346-4752
Practice Address - Street 1:910 FREMONT ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-3105
Practice Address - Country:US
Practice Address - Phone:715-346-4646
Practice Address - Fax:715-346-4752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1006-042261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33278000Medicaid