Provider Demographics
NPI:1013917616
Name:MCNIL CORPORATION
Entity Type:Organization
Organization Name:MCNIL CORPORATION
Other - Org Name:HOMECARE'S BELOIT CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPER MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCNAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-362-1234
Mailing Address - Street 1:1905 HUEBBE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-362-7000
Mailing Address - Fax:608-362-8005
Practice Address - Street 1:1905 HUEBBE PARKWAY
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1842
Practice Address - Country:US
Practice Address - Phone:608-362-7000
Practice Address - Fax:608-362-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7435333600000X
WI74350423336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33203300Medicaid
5101201OtherNABP