Mayer Drug Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

8019-42 Issued in WI

Legal business name

MAYER DRUG INC

Practice address

3535 30TH Ave
Ste 103
Kenosha, WI 53144-1632

Phone

(262) 658-8124

Fax

(262) 564-8667

NPI assigned

Aug 23, 2005

Organization subpart

No

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

Authorized official

Name

Raymond Larsen

Title

President

Phone

(262) 658-8124

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• LARSEN MAYER PHARMACY Doing business as

Locations

Practitioners 1

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

• Philip C Berce, MD

  • Dermatology Physician
  • Oak Creek, WI
  • NPI 1215400031
  NPD (past)

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286323200000",
    "number": "1790778967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 30TH AVE",
            "address_2": "STE 103",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441632",
            "telephone_number": "262-658-8124",
            "fax_number": "262-564-8667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 30TH AVE",
            "address_2": "STE 103",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441632",
            "telephone_number": "262-658-8124",
            "fax_number": "262-564-8667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYER DRUG INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-23",
        "last_updated": "2010-10-06",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-658-8124"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "8019-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5102392",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3305290033069300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LARSEN MAYER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Andrea M Mattison, PAC
• Suzanne P Mattox, MD
• Rebecca B Mauck, CRNA
• Trista Anne Maulson, M.S.
• Kelly Mauser, PTA
• Nicholas R Mayor, MA LPC SAC
• Krystal Mazzulla, RN
• MB Consultants LLC
• Paul Suiven Mbinglo, PHARM D
• Susan J McAley, MA, LPC

• Community/Retail Pharmacy in Kenosha, WI
• Providers in Kenosha, 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 Oct 6, 2010; 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.