Forum Extended Care Services of Wisconsin Inc

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

9417-42 Issued in WI

Legal business name

FORUM EXTENDED CARE SERVICES OF WISCONSIN INC

Practice address

2445 Darwin Rd
Suite 102
Madison, WI 53704-3116

Phone

(608) 240-2280

Fax

(608) 240-2288

NPI assigned

Oct 16, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brian Kramer

Title

President

Phone

(847) 673-8727

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Willow Pharmacy Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1224115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647907200000",
    "number": "1013169598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 W VICTORIA ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606466700",
            "telephone_number": "847-673-8727",
            "fax_number": "847-673-6215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2445 DARWIN RD",
            "address_2": "SUITE 102",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537043116",
            "telephone_number": "608-240-2280",
            "fax_number": "608-240-2288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORUM EXTENDED CARE SERVICES OF WISCONSIN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-16",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-22",
        "status": "A",
        "authorized_official_last_name": "KRAMER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-673-8727"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "WI",
            "license": "9417-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100001648",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2117872",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Willow Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Long Term Care Pharmacy in Madison, WI
• Providers in Madison, WI by specialty
• Long Term Care Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.