Provider Demographics
NPI:1518042944
Name:SCHULTZ PHARMACY INC.
Entity Type:Organization
Organization Name:SCHULTZ PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC OF CORP
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:608-325-2151
Mailing Address - Street 1:1008 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-2005
Mailing Address - Country:US
Mailing Address - Phone:608-325-2151
Mailing Address - Fax:608-325-2153
Practice Address - Street 1:1008 17TH AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-2005
Practice Address - Country:US
Practice Address - Phone:608-325-2151
Practice Address - Fax:608-325-2153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7669 042333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33122200Medicaid
WI0273110002Medicare NSC