Provider Demographics
NPI:1770982050
Name:ST. CROIX FALLS PHARMACY LLC
Entity type:Organization
Organization Name:ST. CROIX FALLS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:TREMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-483-0317
Mailing Address - Street 1:216 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-9449
Mailing Address - Country:US
Mailing Address - Phone:715-483-0426
Mailing Address - Fax:715-483-0516
Practice Address - Street 1:216 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:SAINT CROIX FALLS
Practice Address - State:WI
Practice Address - Zip Code:54024-9449
Practice Address - Country:US
Practice Address - Phone:715-483-0426
Practice Address - Fax:715-483-0516
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. CROIX VALLEY PHARMACIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-22
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9279-423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy