Den Dia IV

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

6162042 Issued in WI

Legal business name

DEN DIA IV

Doing business as

Stowe Drug Store

Practice address

375 Main Ave
De Pere, WI 54115-2202

Phone

(920) 336-6128

NPI assigned

Apr 25, 2007

Organization subpart

No

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

Authorized official

Name

Dennis Larson, RPH

Title

President and Pharmacist

Phone

(920) 336-6128

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• STOWE DRUG STORE Doing business as

Locations

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189555200000",
    "number": "1932328242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 MAIN AVE",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541152202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 MAIN AVE",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541152202",
            "telephone_number": "920-336-6128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEN DIA IV",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-25",
        "last_updated": "2007-09-12",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "PRESIDENT AND PHARMACIST",
        "authorized_official_telephone_number": "920-336-6128",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "6162042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "5103332",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "5103332",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33055200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STOWE DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jennifer Lynn Deneys, PT
• Kelly J. Depas, MSPT
• Katie Depeau, DPT
• Depere School District
• Alyssa Desotell

• Community/Retail Pharmacy in De Pere, WI
• Providers in De Pere, 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 Sep 12, 2007; 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.