IV Compound Center of Wisconsin LLC

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

8543-042 Issued in WI

Legal business name

IV COMPOUND CENTER OF WISCONSIN LLC

Practice address

5478 S Westridge Dr
New Berlin, WI 53151-7948

Phone

(262) 641-2850

Fax

(262) 641-2854

NPI assigned

Mar 30, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Donald Steven Koshak, RPH

Title

Owner

Phone

(262) 641-2850

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1364601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364601600000",
    "number": "1487997235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5478 S WESTRIDGE DR",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531517948",
            "telephone_number": "262-641-2850",
            "fax_number": "262-641-2854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5478 S WESTRIDGE DR",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531517948",
            "telephone_number": "262-641-2850",
            "fax_number": "262-641-2854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IV COMPOUND CENTER OF WISCONSIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-30",
        "last_updated": "2013-03-30",
        "status": "A",
        "authorized_official_last_name": "KOSHAK",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-641-2850",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "WI",
            "license": "8543-042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2013; 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.