NPIMap

Organization Active NPI

Badger Pharmacy LLC

Doing business as Young's Drug Store

  • Community/Retail Pharmacy
  • Merrill, WI
National Provider Identifier
1205164597
Registry record updated Sep 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
9172-42 Issued in WI
Legal business name
BADGER PHARMACY LLC
Doing business as
Young's Drug Store
Practice address
301 E 2ND St
Merrill, WI 54452-2317
Phone
(715) 536-2909
Fax
(715) 536-5094
NPI assigned
Nov 24, 2009
Last updated
Sep 18, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 9172-42 WI
Community/Retail Pharmacy 3336C0003X 9172-42 WI Primary

Addresses

Primary practice location

301 E 2ND St
Merrill, WI 54452-2317

Mailing address

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

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
O20110302000965 WI DME Supplier - Pharmacy 7416139019 Practice locations: Merrill, 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
Tax ID family
Badger Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the 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": "1259020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410998400000",
    "number": "1205164597",
    "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": "301 E 2ND ST",
            "city": "MERRILL",
            "state": "WI",
            "postal_code": "544522317",
            "telephone_number": "715-536-2909",
            "fax_number": "715-536-5094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BADGER PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-24",
        "last_updated": "2014-09-18",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WI",
            "license": "9172-42",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "9172-42",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Young's Drug Store",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Merrill, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.