Provider Demographics
NPI:1497898472
Name:STREUS PHARMACY INC
Entity Type:Organization
Organization Name:STREUS PHARMACY INC
Other - Org Name:STREUS PHARMACY LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIRCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:920-437-0206
Mailing Address - Street 1:528 N MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-4910
Mailing Address - Country:US
Mailing Address - Phone:920-437-0206
Mailing Address - Fax:920-884-6932
Practice Address - Street 1:528 N MONROE AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4910
Practice Address - Country:US
Practice Address - Phone:920-437-0206
Practice Address - Fax:920-884-6932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8504-0423336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33073500Medicaid
WI5128601OtherNABP
WI5128601OtherNABP
WI33073500Medicaid