Provider Demographics
NPI:1982130696
Name:BADGER PHARMACY LLC
Entity Type:Organization
Organization Name:BADGER PHARMACY LLC
Other - Org Name:YOUNG'S - GREENHECK HEALTH/WELLNES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:FORREST
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:YOUNGS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:715-297-8735
Mailing Address - Street 1:555 S 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-9038
Mailing Address - Country:US
Mailing Address - Phone:715-842-0366
Mailing Address - Fax:715-842-0366
Practice Address - Street 1:734 ROSS AVE
Practice Address - Street 2:
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-1860
Practice Address - Country:US
Practice Address - Phone:715-842-0370
Practice Address - Fax:715-842-0366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI89933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy