Provider Demographics
NPI:1881690576
Name:CARDINS PHARMACY, INC
Entity Type:Organization
Organization Name:CARDINS PHARMACY, INC
Other - Org Name:CARDIN'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:608-744-2195
Mailing Address - Street 1:117 W. WEBSTER STREET
Mailing Address - Street 2:
Mailing Address - City:CUBA CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53807-1538
Mailing Address - Country:US
Mailing Address - Phone:608-744-2195
Mailing Address - Fax:608-744-2193
Practice Address - Street 1:117 W. WEBSTER STREET
Practice Address - Street 2:
Practice Address - City:CUBA CITY
Practice Address - State:WI
Practice Address - Zip Code:53807-1538
Practice Address - Country:US
Practice Address - Phone:608-744-2195
Practice Address - Fax:608-744-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8803-0423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33127000Medicaid
WI33127000Medicaid