Provider Demographics
NPI:1689664823
Name:MCGLYNN PHARMACY INC.
Entity Type:Organization
Organization Name:MCGLYNN PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCGLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:608-873-3244
Mailing Address - Street 1:100 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-1721
Mailing Address - Country:US
Mailing Address - Phone:608-873-3244
Mailing Address - Fax:608-873-4023
Practice Address - Street 1:100 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-1721
Practice Address - Country:US
Practice Address - Phone:608-873-3244
Practice Address - Fax:608-873-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8121332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33258800Medicaid
WI5103053OtherNABP
WI33258800Medicaid