Provider Demographics
NPI:1972725240
Name:HO CHUNK NATION
Entity Type:Organization
Organization Name:HO CHUNK NATION
Other - Org Name:HOUSE OF WELLNESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DEPT DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:WALLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:APLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-284-9851
Mailing Address - Street 1:S2845 WHITE EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-9064
Mailing Address - Country:US
Mailing Address - Phone:608-355-1240
Mailing Address - Fax:608-356-1233
Practice Address - Street 1:S2845 WHITE EAGLE RD
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-9064
Practice Address - Country:US
Practice Address - Phone:608-355-5177
Practice Address - Fax:608-356-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8332-42332800000X
333600000X, 3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2109072OtherPK
WI33246800Medicaid
WI5125516OtherNCPDP