Provider Demographics
NPI:1629530837
Name:ABBOTSFORD PHARMACY INC
Entity Type:Organization
Organization Name:ABBOTSFORD PHARMACY INC
Other - Org Name:ABBOTSFORD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-418-3478
Mailing Address - Street 1:206 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ABBOTSFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54405-9413
Mailing Address - Country:US
Mailing Address - Phone:715-721-6068
Mailing Address - Fax:715-316-0021
Practice Address - Street 1:206 N 4TH ST
Practice Address - Street 2:
Practice Address - City:ABBOTSFORD
Practice Address - State:WI
Practice Address - Zip Code:54405-9413
Practice Address - Country:US
Practice Address - Phone:715-715-7216
Practice Address - Fax:715-316-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy