Stowe Drug Store

LBN: Den Dia Iv
Stowe Drug Store is an health care organization with primary practice located at 375 Main Ave , De Pere WI 54115-2202. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Den Dia Iv can be contacted via phone (920) 336-6128, or through Larson, Dennis via phone (920) 336-6128.

Contact Information

Primary practice address
375 Main Ave De Pere WI 54115-2202
Phone: (920) 336-6128
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Larson, Dennis RPH
Phone: (920) 336-6128

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X 6162042 Wisconsin

Profile Details

NPI number 1932328242
LBN Legal business name Den Dia Iv
DBA Doing business as Stowe Drug Store
Authorized official Larson, Dennis RPH
Entity Organization
Organization subpart 1 No
Enumeration date Apr 25th, 2007
Last updated Sep 12th, 2007 - about 19 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932328242 NPPES
Other 5103332 OTHER ID NUMBER
Other 5103332 OTHER ID NUMBER
MEDICAID 33055200 OTHER ID NUMBER

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