NPIMap

Organization Active NPI

Cedarburg Prescription Center, Inc

Doing business as LTC North Shore Pharmacy & Compounding Center

  • Long Term Care Pharmacy
  • Cedarburg, WI
National Provider Identifier
1306448246
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
CEDARBURG PRESCRIPTION CENTER, INC
Doing business as
LTC North Shore Pharmacy & Compounding Center
Practice address
N54 W6135 Mill Street
Suite 300
Cedarburg, WI 53012
Phone
(262) 375-0010
Fax
(262) 375-0080
NPI assigned
Nov 16, 2020
Last updated
May 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2024

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

Authorized official

Name
Kyle Beyer
Title
Owner
Phone
(414) 232-4103

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

N54 W6135 Mill Street
Suite 300
Cedarburg, WI 53012

Mailing address

N54 W6135 Mill Street
Suite 300
Cedarburg, WI 53012
Phone (262) 375-0010

Other identifiers 1

IdentifierTypeStateIssuer
33233800MedicaidWI

Other names 1

  • LTC North Shore Pharmacy & Compounding Center Doing business as

National Provider Directory

National Provider Directory

Locations

N54W6135 Mill St
Ste 300
Cedarburg, WI 53012
Phone (262) 375-0010

Practitioners & affiliated clinicians

Practitioners 6

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": "1605484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715212800000",
    "number": "1306448246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N54 W6135 MILL STREET",
            "address_2": "SUITE 300",
            "city": "CEDARBURG",
            "state": "WI",
            "postal_code": "53012",
            "telephone_number": "262-375-0010",
            "fax_number": "262-375-0080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N54 W6135 MILL STREET",
            "address_2": "SUITE 300",
            "city": "CEDARBURG",
            "state": "WI",
            "postal_code": "53012",
            "telephone_number": "262-375-0010",
            "fax_number": "262-375-0080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDARBURG PRESCRIPTION CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-16",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A",
        "authorized_official_last_name": "BEYER",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-232-4103"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33233800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LTC North Shore Pharmacy & Compounding Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LTC North Shore Pharmacy & Compounding Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cedarburg, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; 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.