Jerrys Enterprises Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

8363-42 Issued in WI

Legal business name

JERRYS ENTERPRISES INC

Practice address

2310 Crest View Dr
Hudson, WI 54016-9315

Phone

(715) 381-5923

Fax

(715) 381-5993

NPI assigned

Sep 30, 2006

Organization subpart

No

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

Authorized official

Name

Joyce Larson, R.PH.

Title

Controller

Phone

(952) 928-1698

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• COUNTY MARKET PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Jerrys Enterprises Inc

  • Community/Retail Pharmacy
  • Wausau, WI
  • NPI 1588778575

  2365659364

  Same PAC ID

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kay Christine Bramer

  • Pharmacist
  • Hudson, WI
  • NPI 1841276938
  NPD
• David James Burish, RPH.

  • Pharmacist
  • Wausau, WI
  • NPI 1932146743
  NPD
• Keith Robert Hoehn, RPH

  • Pharmacist
  • Wausau, WI
  • NPI 1649564527
  NPD
• Sherry Krueger, RPH

  • Pharmacist
  • Hudson, WI
  • NPI 1699376780
  NPD

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

{
    "created_epoch": "1159574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487548800000",
    "number": "1609969039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 CREST VIEW DR",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540169315",
            "telephone_number": "715-381-5923",
            "fax_number": "715-381-5993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 CREST VIEW DR",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540169315",
            "telephone_number": "715-381-5923",
            "fax_number": "715-381-5993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRYS ENTERPRISES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-30",
        "last_updated": "2017-02-20",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "JOYCE",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "952-928-1698",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "8363-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2108748",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33272100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COUNTY MARKET PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kirk L Jacobson, MD
• James Broecker PA
• Laura James, BS
• Brenton Curtis Jenkins, MD
• Stephanie Jensen, LCSW
• Jill Ann Anderson and Associates, LLC
• Jka5 Hudson Inc
• Victoria Jean Johanneck, PSY.D., M.DIV.
• Brooke Catherine John
• Michele Johnsen

• Community/Retail Pharmacy in Hudson, WI
• Providers in Hudson, 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 Feb 20, 2017; 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.