Restore Health Pharmacy, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

9070-042 Issued in WI

Legal business name

RESTORE HEALTH PHARMACY, LLC

Doing business as

Restore Health Pharmacy, LLC

Practice address

1289 Deming Way
Madison, WI 53717-2007

Phone

(800) 558-7046

Fax

(888) 898-7412

NPI assigned

May 6, 2011

Last updated

Feb 23, 2015By 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

Matthew Wanderer, PHARMD

Title

Ceo

Phone

(480) 421-8005

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Restore Health Pharmacy, LLC Doing business as

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

{
    "created_epoch": "1304640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424649600000",
    "number": "1750673919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1289 DEMING WAY",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537172007",
            "telephone_number": "800-558-7046",
            "fax_number": "888-898-7412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1289 DEMING WAY",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537172007",
            "telephone_number": "800-558-7046",
            "fax_number": "888-898-7412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE HEALTH PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-06",
        "last_updated": "2015-02-23",
        "status": "A",
        "authorized_official_last_name": "WANDERER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-421-8005",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "9070-042",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2130190",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Restore Health Pharmacy, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jeremy Reutebuch, BA
• Katherine Dawn Reuter Munoz, MD

• Community/Retail Pharmacy in Madison, WI
• Providers in Madison, 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 23, 2015; 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.