Provider Demographics
NPI:1891439154
Name:WAUSAU FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:WAUSAU FAMILY PHARMACY LLC
Other - Org Name:WAUSAU FAMILY PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ZOUA
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:715-567-5600
Mailing Address - Street 1:161940 GUSMAN RD
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2129
Mailing Address - Country:US
Mailing Address - Phone:715-567-5500
Mailing Address - Fax:715-298-0494
Practice Address - Street 1:630 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-5352
Practice Address - Country:US
Practice Address - Phone:715-701-0822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-22
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100206237Medicaid