River Prairie Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

RIVER PRAIRIE PHARMACY

Practice address

1490 Rivers Edge TRL
Altoona, WI 54720-2755

Phone

(715) 828-2368

Fax

(715) 839-7796

NPI assigned

Apr 20, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Robert Joseph Defatta, MD

Title

Owner

Phone

(715) 828-2368

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1618876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618876800000",
    "number": "1598346587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1490 RIVERS EDGE TRL",
            "city": "ALTOONA",
            "state": "WI",
            "postal_code": "547202755",
            "telephone_number": "715-828-2368",
            "fax_number": "715-839-7796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1490 RIVERS EDGE TRL",
            "city": "ALTOONA",
            "state": "WI",
            "postal_code": "547202755",
            "telephone_number": "715-828-2368",
            "fax_number": "715-839-7796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER PRAIRIE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-20",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A",
        "authorized_official_last_name": "DEFATTA",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-828-2368",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in Altoona, WI
• Providers in Altoona, 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 Apr 20, 2021; 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.