Provider Demographics
NPI:1891132999
Name:THRIVE HEALTH CENTER PHARMACY
Entity Type:Organization
Organization Name:THRIVE HEALTH CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LATTOS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:608-519-4622
Mailing Address - Street 1:831 CRITTER CT
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8674
Mailing Address - Country:US
Mailing Address - Phone:608-519-4622
Mailing Address - Fax:608-519-4612
Practice Address - Street 1:831 CRITTER CT
Practice Address - Street 2:SUITE 300
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8674
Practice Address - Country:US
Practice Address - Phone:608-519-4622
Practice Address - Fax:608-519-4612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9198-423336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy