NPIMap

Organization Active NPI

Badger Pharmacy LLC

Doing business as Young's Drug Store

  • Community/Retail Pharmacy
  • Wausau, WI
National Provider Identifier
1073628020
Registry record updated Aug 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
8995-42 Issued in WI
Legal business name
BADGER PHARMACY LLC
Doing business as
Young's Drug Store
Practice address
310 E Bridge St
Wausau, WI 54403-3589
Phone
(715) 845-5203
Fax
(715) 843-0883
NPI assigned
Aug 20, 2006
Last updated
Aug 4, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2014

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

Authorized official

Name
Forrest Young, RPHNPI 1629985205
Title
Owner
Phone
(715) 842-0370

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 8995-42 WI Primary

Addresses

Primary practice location

310 E Bridge St
Wausau, WI 54403-3589

Mailing address

555 S 72ND Ave
Wausau, WI 54401-9038
Phone (715) 842-0370

Other identifiers 2

IdentifierTypeStateIssuer
1073628020MedicaidWI
5113600OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Young's Drug Store Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110502000175 WI DME Supplier - Pharmacy 7416139019 Practice locations: Wausau, WI

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

2106 Grand Ave
Wausau, WI 54403
Phone (715) 845-3713

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407110400000",
    "number": "1073628020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 S 72ND AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544019038",
            "telephone_number": "715-842-0370",
            "fax_number": "715-842-0366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 E BRIDGE ST",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544033589",
            "telephone_number": "715-845-5203",
            "fax_number": "715-843-0883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BADGER PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2014-08-04",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "FORREST",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-842-0370",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "8995-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073628020",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5113600",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Young's Drug Store",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wausau, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.