Whitefish Bay Prescription Center LTD
Organization Active NPI Community/Retail Pharmacy · Glendale, WI
NPI 1790793446 · NPPES record last updated Oct 24, 2008
Key facts
- NPI
- 1790793446
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 7296 (WI)
- Legal business name
- WHITEFISH BAY PRESCRIPTION CENTER LTD
- Practice address
- 5320 N Port Washington Rd
Glendale, WI 53217 - Phone
- (414) 963-0811
- Fax
- (414) 963-0830
- NPI assigned
- Aug 4, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. John Stephen Waclawski, RPH
- Title
- President
- Phone
- (414) 963-0811
Practitioners 3
-
Jay Bubrick, RPH
-
William Joseph Ross, RPH
National Provider Directory
Locations
5320 N Port Washington Rd
Glendale, WI 53217
Phone (414) 963-0811
8822 N Port Washington Rd
Milwaukee, WI 53217
Phone (414) 963-0811
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist |
183500000X | 8527 | WI | |
| Community/Retail Pharmacy | 3336C0003X | 7296 | WI | Yes |
Addresses
Primary practice location
5320 N Port Washington Rd
Glendale, WI 53217
Mailing address
5320 N Port Washington Rd
Glendale, WI 53217
Phone (414) 963-0811
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33002200 | Medicaid | WI |
Other names
- Ye Olde Pharmacy
Other providers in Glendale, WI
- Wellspring Wisconsin LLC
- Candace Wendlick
- John Michael Werwie
- Nancy Lynn Wesling
- Linda M Wesp
- Wi CBT Center LLC
- Brenna Wiczek
- Caitlin Williams-Uecker
- Brit Marie Williams-Van Klooster
- Kenyada M Williams
All providers in Glendale, WI · Community/Retail Pharmacy in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.