Provider Demographics
NPI:1922175066
Name:OSTERBAUER DRUGS LTD
Entity Type:Organization
Organization Name:OSTERBAUER DRUGS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTERBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:715-234-3969
Mailing Address - Street 1:312 W KNAPP ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-1631
Mailing Address - Country:US
Mailing Address - Phone:715-234-3969
Mailing Address - Fax:
Practice Address - Street 1:312 W KNAPP ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1631
Practice Address - Country:US
Practice Address - Phone:715-234-3969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9117-423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33073200Medicaid
5109067OtherNCPDP
5109067OtherNCPDP