Cedar Lake Pharmacy

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

5115503 Issued in WI

Legal business name

CEDAR LAKE PHARMACY

Practice address

5595 County Road Z
West Bend, WI 53095-9224

Phone

(262) 306-2117

Fax

(262) 306-2126

NPI assigned

Mar 23, 2007

Organization subpart

No

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

Authorized official

Name

Chris Cherney

Title

Cfo

Phone

(262) 306-4212

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• CEDAR LAKE PAHRMACY-DME Doing business as

Tax ID family

Benevolent Corporation Cedar Community2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Benevolent Corporation Cedar Community

  • Assisted Living Facility
  • West Bend, WI
  • NPI 1972054138
  NPD tax ID

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881711935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5595 COUNTY ROAD Z",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959224",
            "telephone_number": "262-306-2117",
            "fax_number": "262-306-2126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5595 COUNTY ROAD Z",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959224",
            "telephone_number": "262-306-2117",
            "fax_number": "262-306-2126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR LAKE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHERNEY",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "262-306-4212"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WI",
            "license": "5115503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20125800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CEDAR LAKE PAHRMACY-DME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nichole Carstens, ATC, LAT
• Christina Cash, PHARMD, CAA
• Krystina Castillo
• CD Logistic Services
• Cedar Lake Dental Professionals LTD
• Leah Celarek-Stellpflug
• Hayley Cessna, PHARMD
• Anitria Chairse
• Kari L Chakrabarti, CRNA
• Denelle M Chapman, LPC-IT

• Durable Medical Equipment & Medical Supplies in West Bend, WI
• Providers in West Bend, WI by specialty
• Durable Medical Equipment & Medical Supplies in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.