NPIMap

Organization Active NPI

Elkhorn Pharmacy LTD

  • Pharmacist
  • Elkhorn, WI
National Provider Identifier
1326145152
Registry record updated Apr 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
Legal business name
ELKHORN PHARMACY LTD
Practice address
603 E Geneva St
Elkhorn, WI 53121-2301
Phone
(262) 723-8444
Fax
(262) 723-8760
NPI assigned
Sep 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2023

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

Authorized official

Name
May Herning Kue, PHARM D
Title
Owner/Manager
Phone
(262) 723-8444

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193400000X SINGLE SPECIALTY GROUP 183500000X Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

603 E Geneva St
Elkhorn, WI 53121-2301

Mailing address

603 East Geneva Street
Elkhorn, WI 53121
Phone (262) 723-8444

Other identifiers 1

IdentifierTypeStateIssuer
33199000MedicaidWI

Other names 2

  • PLAZA PHARMACY Doing business as
  • Elkhorn Pharmacy Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930030681 WI DME Supplier - Pharmacy 1850411729 Practice locations: Elkhorn, WI
O20220126002679 WI Part B Supplier - Mass Immunization (Roster Biller Only) 1850411729 Practice locations: Elkhorn, WI

National Provider Directory

National Provider Directory
Tax ID family
Elkhorn Pharmacy LTD3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681257600000",
    "number": "1326145152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 EAST GENEVA STREET",
            "city": "ELKHORN",
            "state": "WI",
            "postal_code": "53121",
            "telephone_number": "262-723-8444",
            "fax_number": "262-723-8760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 E GENEVA ST",
            "city": "ELKHORN",
            "state": "WI",
            "postal_code": "531212301",
            "telephone_number": "262-723-8444",
            "fax_number": "262-723-8760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELKHORN PHARMACY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A",
        "authorized_official_last_name": "KUE",
        "authorized_official_first_name": "MAY",
        "authorized_official_middle_name": "HERNING",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "262-723-8444",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33199000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PLAZA PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PLAZA PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Elkhorn Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Elkhorn, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 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.