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Contact Information

RESTORE HEALTH PHARMACY, LLC
1289 DEMING WAY
MADISON, WI53717-2007
 Phone: 800-558-7046
 Fax: 888-898-7412
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Compounding Pharmacy

3336C0004X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for RESTORE HEALTH PHARMACY, LLC

NPI # 1750673919
LBN Legal business name RESTORE HEALTH PHARMACY, LLC
Authorized official MATTHEW WANDERER - (CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 05/06/2011
Last updated 02/23/2015 - About 11 years ago
Identifiers
WI License # 9070-042
Other 2130190 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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