Provider Demographics
NPI:1629162268
Name:SPRING GREEN PHARMACY INC
Entity Type:Organization
Organization Name:SPRING GREEN PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:608-588-2541
Mailing Address - Street 1:208 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SPRING GREEN
Mailing Address - State:WI
Mailing Address - Zip Code:53588-8002
Mailing Address - Country:US
Mailing Address - Phone:608-588-2541
Mailing Address - Fax:
Practice Address - Street 1:208 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SPRING GREEN
Practice Address - State:WI
Practice Address - Zip Code:53588-8002
Practice Address - Country:US
Practice Address - Phone:608-588-2541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6137-0423336C0003X
WI61373336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0271830001Medicare NSC