PHARMACY HOLDING COMPANY OF WISCONSIN LLC

Compounding Pharmacy

A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner?s Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice. A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice.

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Contact Information

PHARMACY HOLDING COMPANY OF WISCONSIN LLC

1256 OLD 51 S
ARBOR VITAE, WI 54568-9793

Phone: 715-358-4070
Fax: 715-358-4072
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Compounding Pharmacy	3336C0004X	58	Medical Supply Company with Pharmacist
Mail Order Pharmacy	3336M0002X	58	Medical Supply Company with Pharmacist
Pharmacy	333600000X	58	Medical Supply Company with Pharmacist

Indicates primary specialty

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NPI Profile & details for PHARMACY HOLDING COMPANY OF WISCONSIN LLC

NPI Number 1003175266

LBN Legal business name PHARMACY HOLDING COMPANY OF WISCONSIN LLC

Authorized official CHERYL HULL - (OWNER/MEMBER)

Entity Organization

Organization subpart ¹ No

Enumeration date 05/09/2012

Last updated 02/22/2013 - About 13 years ago

Identifiers

FL	License #	PH25982
MS	License #	11215/7.1
NE	License #	696
WI	License #	9082-042
	Other	5133169	NCPDP PROVIDER IDENTIFICATION NUMBER

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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