Provider Demographics
NPI:1609832500
Name:RASMUSSEN VILLAGE PHARMACY, INC.
Entity Type:Organization
Organization Name:RASMUSSEN VILLAGE PHARMACY, INC.
Other - Org Name:VILLAGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:WILLINK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:715-684-2674
Mailing Address - Street 1:PO BOX 15
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:WI
Mailing Address - Zip Code:54002-0015
Mailing Address - Country:US
Mailing Address - Phone:715-684-2674
Mailing Address - Fax:715-684-4076
Practice Address - Street 1:840 MAIN ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-0015
Practice Address - Country:US
Practice Address - Phone:715-684-2674
Practice Address - Fax:715-684-4076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5105110OtherNCPDP
WI33079900Medicaid
WI33079900Medicaid