Provider Demographics
NPI:1720224678
Name:DJH INC
Entity Type:Organization
Organization Name:DJH INC
Other - Org Name:THREE LAKES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HAPKA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:715-546-3266
Mailing Address - Street 1:1790 SUPERIOR STREET
Mailing Address - Street 2:
Mailing Address - City:THREE LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:54562-0437
Mailing Address - Country:US
Mailing Address - Phone:715-546-3266
Mailing Address - Fax:715-546-2912
Practice Address - Street 1:1790 SUPERIOR STREET
Practice Address - Street 2:
Practice Address - City:THREE LAKES
Practice Address - State:WI
Practice Address - Zip Code:54562-0437
Practice Address - Country:US
Practice Address - Phone:715-546-3266
Practice Address - Fax:715-546-2912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-24
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33054800Medicaid
WI33054800Medicaid
WI0899370001Medicare UPIN