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Contact Information

PESHTIGO HOMETOWN PHARMACY LLC
960 FRONTAGE RD
PESHTIGO, WI54157-1702
 Phone: 715-582-0898
 Fax: 715-582-0897
 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
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for PESHTIGO HOMETOWN PHARMACY LLC

NPI # 1801262662
LBN Legal business name PESHTIGO HOMETOWN PHARMACY LLC
Authorized official DANIEL STRAUSE - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 08/17/2015
Last updated 09/09/2025 - About 9 months ago
Identifiers
WI License # 9341-42
WI Medicaid 100304952
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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