NPIMap

Organization Active NPI

Pharmacare LTD

  • Community/Retail Pharmacy
  • Augusta, WI
National Provider Identifier
1104928902
Registry record updated May 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
PHARMACARE LTD
Practice address
153 W Lincoln St
Augusta, WI 54722-9152
Phone
(715) 286-2515
Fax
(715) 286-4102
NPI assigned
Sep 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2023

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

Authorized official

Name
Brandin Henke
Title
Credentialing
Phone
(715) 833-6770

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary
Compounding Pharmacy 3336C0004X
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

153 W Lincoln St
Augusta, WI 54722-9152

Mailing address

PO Box 364
Augusta, WI 54722-0364
Phone (715) 286-2515

Other identifiers 1

IdentifierTypeStateIssuer
33263400MedicaidWI

Other names 1

  • Wally Shong Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930060346 WI DME Supplier - Pharmacy 4082829601 Practice locations: Augusta, WI
O20120202000575 WI Part B Supplier - Mass Immunization (Roster Biller Only) 4082829601 10 other NPIs on this enrollment
Practice locations: Whitehall, WI; Bloomer, WI; Mondovi, WI; Barron, WI; Chetek, WI; Augusta, WI

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Pharmacare LTD10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1157155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683763200000",
    "number": "1104928902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 364",
            "city": "AUGUSTA",
            "state": "WI",
            "postal_code": "547220364",
            "telephone_number": "715-286-2515",
            "fax_number": "715-286-4102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 W LINCOLN ST",
            "city": "AUGUSTA",
            "state": "WI",
            "postal_code": "547229152",
            "telephone_number": "715-286-2515",
            "fax_number": "715-286-4102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMACARE LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-02",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A",
        "authorized_official_last_name": "HENKE",
        "authorized_official_first_name": "BRANDIN",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "715-833-6770"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33263400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wally Shong Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Augusta, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2023; 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.