Provider Demographics
NPI:1497766232
Name:WHITE CROSS PHARMACY INC
Entity Type:Organization
Organization Name:WHITE CROSS PHARMACY INC
Other - Org Name:WHITE CROSS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PECHACEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-762-3283
Mailing Address - Street 1:138 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:PARK FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54552-1214
Mailing Address - Country:US
Mailing Address - Phone:715-762-3283
Mailing Address - Fax:715-762-2980
Practice Address - Street 1:314 SILVER ST
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:WI
Practice Address - Zip Code:54534-1254
Practice Address - Country:US
Practice Address - Phone:715-561-5666
Practice Address - Fax:715-561-5654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
WI8951-423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122378OtherPK
5106299OtherNCPDP PROVIDER IDENTIFICATION NUMBER