Provider Demographics
NPI:1922738970
Name:GWIDT PHARMACY INC
Entity Type:Organization
Organization Name:GWIDT PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:STARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-848-3721
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154-0129
Mailing Address - Country:US
Mailing Address - Phone:920-848-3721
Mailing Address - Fax:920-848-4374
Practice Address - Street 1:323 E HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-1006
Practice Address - Country:US
Practice Address - Phone:920-848-3721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GWIDT PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy