Provider Demographics
NPI:1558092429
Name:GWIDT PHARMACY INC
Entity Type:Organization
Organization Name:GWIDT PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:RESCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D, RPH
Authorized Official - Phone:715-253-2164
Mailing Address - Street 1:PO BOX 253
Mailing Address - Street 2:
Mailing Address - City:WITTENBERG
Mailing Address - State:WI
Mailing Address - Zip Code:54499-0253
Mailing Address - Country:US
Mailing Address - Phone:715-253-2164
Mailing Address - Fax:715-253-3030
Practice Address - Street 1:203 E WESTGOR AVE
Practice Address - Street 2:
Practice Address - City:WITTENBERG
Practice Address - State:WI
Practice Address - Zip Code:54499-9174
Practice Address - Country:US
Practice Address - Phone:715-253-2164
Practice Address - Fax:715-253-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy