Provider Demographics
NPI:1851098990
Name:TOMAHAWK PHARMACY LLC
Entity Type:Organization
Organization Name:TOMAHAWK PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-453-6600
Mailing Address - Street 1:315 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-1133
Mailing Address - Country:US
Mailing Address - Phone:715-453-6600
Mailing Address - Fax:715-453-6601
Practice Address - Street 1:315 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487-1133
Practice Address - Country:US
Practice Address - Phone:715-453-6600
Practice Address - Fax:715-453-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100126644Medicaid