Provider Demographics
NPI:1568574481
Name:PAPER VALLEY PHARMACIES
Entity Type:Organization
Organization Name:PAPER VALLEY PHARMACIES
Other - Org Name:FORD PHARMACY NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:920-738-4110
Mailing Address - Street 1:2725 N MEADE ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-2201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2725 N MEADE ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-2201
Practice Address - Country:US
Practice Address - Phone:920-738-4110
Practice Address - Fax:920-738-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7243042333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5121164OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WI33187400Medicaid
WI33187400Medicaid