Provider Demographics
NPI:1942314570
Name:PHARMACEUTICAL SERVICES INC
Entity Type:Organization
Organization Name:PHARMACEUTICAL SERVICES INC
Other - Org Name:WEST BEND ASSISTED LIVING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:NIEBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:262-677-1401
Mailing Address - Street 1:W209N17321 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WI
Mailing Address - Zip Code:53037-9389
Mailing Address - Country:US
Mailing Address - Phone:262-677-1401
Mailing Address - Fax:262-677-9112
Practice Address - Street 1:W209 N17321 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WI
Practice Address - Zip Code:53037-9389
Practice Address - Country:US
Practice Address - Phone:262-677-1401
Practice Address - Fax:262-677-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI84820423336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33243200Medicaid
0228960009Medicare NSC