NPIMap

Organization Active NPI

Badger Pharmacy LLC

Doing business as Young's Drug Store

  • Community/Retail Pharmacy
  • Wausau, WI
National Provider Identifier
1124358940
Registry record updated Aug 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
8993-042 Issued in WI
Legal business name
BADGER PHARMACY LLC
Doing business as
Young's Drug Store
Practice address
2106 Grand Ave
Wausau, WI 54403-6912
Phone
(715) 845-3713
Fax
(715) 845-7957
NPI assigned
Dec 29, 2009
Last updated
Aug 5, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2014

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

Authorized official

Name
Forrest YoungNPI 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 8993-042 WI Primary

Addresses

Primary practice location

2106 Grand Ave
Wausau, WI 54403-6912

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
1124358940MedicaidWI
5132131OtherNCPDP

Other names 1

  • Young's Drug Store Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1262044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407196800000",
    "number": "1124358940",
    "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": "2106 GRAND AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544036912",
            "telephone_number": "715-845-3713",
            "fax_number": "715-845-7957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BADGER PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-29",
        "last_updated": "2014-08-05",
        "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"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "8993-042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124358940",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "5132131",
            "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 5, 2014; 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.