Shell Lake Pharmacy LTD

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SHELL LAKE PHARMACY LTD

Practice address

113 4TH Ave
Shell Lake, WI 54871-4457

Phone

(715) 468-7800

Fax

(715) 468-7921

NPI assigned

Nov 14, 2006

Last updated

Oct 4, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Paige Wiles

Title

Admin Assistant

Phone

(715) 418-3478

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Tax ID family

Shell Lake Pharmacy LTD2 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.

• Shell Lake Pharmacy LTD

  • Long Term Care Pharmacy
  • Shell Lake, WI
  • NPI 1962920926
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728000000000",
    "number": "1356413850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 343",
            "city": "SHELL LAKE",
            "state": "WI",
            "postal_code": "548710343",
            "telephone_number": "715-468-7800",
            "fax_number": "715-468-7921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 4TH AVE",
            "city": "SHELL LAKE",
            "state": "WI",
            "postal_code": "548714457",
            "telephone_number": "715-468-7800",
            "fax_number": "715-468-7921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELL LAKE PHARMACY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A",
        "authorized_official_last_name": "WILES",
        "authorized_official_first_name": "PAIGE",
        "authorized_official_title_or_position": "ADMIN ASSISTANT",
        "authorized_official_telephone_number": "715-418-3478"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WI",
            "license": "6461042",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33038100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Schulz, QTT
• Shell Lake Clinic, LTD
• Shell Lake Clinic, LTD
• Shell Lake Cumberland Chiropractic Clinics LLC
• Shell Lake Cumberland Chiropractic Clinics LLC
• Shell Lake Pharmacy LTD
• Shell Lake SNF LLC (Shell Lake Health Care Center)
• Nancy Lee Skow, RN
• Soar Services, Inc.
• Jessi Rai Stouffer, COTA

• Community/Retail Pharmacy in Shell Lake, WI
• Providers in Shell Lake, WI by specialty
• Community/Retail Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; 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.