Provider Demographics
NPI:1982943924
Name:DISTRICT COUNCIL OF MADISON INC
Entity Type:Organization
Organization Name:DISTRICT COUNCIL OF MADISON INC
Other - Org Name:ST. VINCENT DE PAUL CHARITABLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-268-0355
Mailing Address - Street 1:PO BOX 259686
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53725-9686
Mailing Address - Country:US
Mailing Address - Phone:608-442-7200
Mailing Address - Fax:608-442-7211
Practice Address - Street 1:2033 FISH HATCHERY RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53725-9686
Practice Address - Country:US
Practice Address - Phone:608-268-0355
Practice Address - Fax:608-237-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9183-423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2138923OtherPK