NPIMap

Organization Active NPI

Gwidt Pharmacy Inc

Doing business as Oconto Falls Pharmacy

  • Community/Retail Pharmacy
  • Oconto Falls, WI
National Provider Identifier
1245319912
Registry record updated May 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
7999-42 Issued in WI
Legal business name
GWIDT PHARMACY INC
Doing business as
Oconto Falls Pharmacy
Practice address
323 E Highland Dr
Oconto Falls, WI 54154-1006
Phone
(920) 848-3721
Fax
(920) 848-4374
NPI assigned
Nov 3, 2006
Last updated
May 1, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2017

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

Authorized official

Name
Timothy Starry, B.S. PHARMNPI 1215324629
Title
President
Phone
(920) 848-3721

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 7999-42 WI Primary

Addresses

Primary practice location

323 E Highland Dr
Oconto Falls, WI 54154-1006

Mailing address

PO Box 129
Oconto Falls, WI 54154-0129
Phone (920) 848-3721

Other identifiers 2

IdentifierTypeStateIssuer
2112905OtherPK
33213600MedicaidWI

Other names 1

  • OCONTO FALLS 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
O20100930000306 WI DME Supplier - Pharmacy 3375669930 Practice locations: Oconto Falls, WI
O20130325000049 WI Part B Supplier - Mass Immunization (Roster Biller Only) 3375669930 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wittenberg, WI; Oconto Falls, WI

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Gwidt Pharmacy Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

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": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493596800000",
    "number": "1245319912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 129",
            "city": "OCONTO FALLS",
            "state": "WI",
            "postal_code": "541540129",
            "telephone_number": "920-848-3721",
            "fax_number": "920-848-4374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 E HIGHLAND DR",
            "city": "OCONTO FALLS",
            "state": "WI",
            "postal_code": "541541006",
            "telephone_number": "920-848-3721",
            "fax_number": "920-848-4374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GWIDT PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2017-05-01",
        "status": "A",
        "authorized_official_last_name": "STARRY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-848-3721",
        "authorized_official_credential": "B.S. PHARM"
    },
    "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": "7999-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2112905",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33213600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OCONTO FALLS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oconto Falls, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2017; 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.