Provider Demographics
NPI:1619926854
Name:TARGET PHARMACY T-1060
Entity Type:Organization
Organization Name:TARGET PHARMACY T-1060
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY TEAM LEADER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:608-827-9483
Mailing Address - Street 1:201 JUNCTION RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2615
Mailing Address - Country:US
Mailing Address - Phone:608-827-9483
Mailing Address - Fax:608-827-9483
Practice Address - Street 1:201 JUNCTION RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2615
Practice Address - Country:US
Practice Address - Phone:608-827-9483
Practice Address - Fax:608-827-9483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8075261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33255700Medicaid
WI5126253OtherNABP OR NCPDP NUMBER
WI8075OtherPHARMACY LICENSE NUMBER
WI5126253OtherNABP OR NCPDP NUMBER