Lake Mills Hometown Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

9469-42 Issued in WI

Legal business name

LAKE MILLS HOMETOWN PHARMACY LLC

Practice address

372 E Tyranena Park Rd
Lake Mills, WI 53551-9680

Phone

(920) 945-2500

Fax

(920) 945-2503

NPI assigned

Jun 26, 2017

Organization subpart

No

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

Authorized official

Name

Daniel Strause

Title

Ceo

Phone

(920) 992-6800

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• LAKE MILLS HOMETOWN PHARMACY Doing business as

Locations

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

{
    "created_epoch": "1498435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592956800000",
    "number": "1720508245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 LOWVILLE RD",
            "city": "RIO",
            "state": "WI",
            "postal_code": "539609437",
            "telephone_number": "920-992-6800",
            "fax_number": "920-992-6801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "372 E TYRANENA PARK RD",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "535519680",
            "telephone_number": "920-945-2500",
            "fax_number": "920-945-2503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MILLS HOMETOWN PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-26",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A",
        "authorized_official_last_name": "STRAUSE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "920-992-6800"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "9469-42",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100070330",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKE MILLS HOMETOWN PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LAKE MILLS HOMETOWN PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Lake Mills, WI
• Providers in Lake Mills, 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 Jun 24, 2020; 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.