BEAVER DAM HOMETOWN PHARMACY LLC (NPI# 1588036826) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588036826 |
| Entity Type | Organization |
| Organization Name | BEAVER DAM HOMETOWN PHARMACY LLC |
| Other Organization Name | BEAVER DAM HOMETOWN PHARMACY |
| Practice Address |
609 N Spring St Beaver Dam WI 53916-2040 |
| Mailing Address |
333 Lowville Rd Rio WI 53960-9437 |
| Practice Telephone | 9203561500 |
| Practice Fax Number | 9203561510 |
| Mailing Telephone | 9209926800 |
| Mailing Fax Number | 9209926801 |
| Enumeration Date | 2015-10-27 |
| Last Update Date | 2020-05-04 |
| Authorized Official Name | DANIEL STRAUSE (CEO) |
| Authorized Official Telephone | 9209926800 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| N | 3336S0011X |
Pharmacy Specialization: Specialty Pharmacy |
Suppliers | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 333600000X | Pharmacy | 9411-42 | WI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 100050583 | 05 | |
| PK | 2155039 | 01 |
| Other Name | Type Code |
|---|---|
| BEAVER DAM HOMETOWN PHARMACY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881066702 | Beaver Dam Hometown Pharmacy LLC | Pharmacy | 333 Lowville Rd, Rio, WI 53960 | 2015-10-30 |
| Street Address |
609 N SPRING ST |
| City | BEAVER DAM |
| State | WI |
| Zip Code | 53916-2040 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487093852 | Allison Kay Walker | Pharmacist | 609 N Spring St, Beaver Dam, WI 53916-2040 | 2013-06-19 |
| 1215548516 | Blair Adam Baillio | Pharmacist | 609 N Spring St, Beaver Dam, WI 53916-2040 | 2020-08-11 |
| 1811539331 | Ahamed A Ahamed | Pharmacist | 609 N Spring St, Beaver Dam, WI 53916-2040 | 2019-10-16 |
| 1457835662 | Mariam Khan | Pharmacist | 609 N Spring St, Beaver Dam, WI 53916-2040 | 2018-09-24 |
| 1396114369 | Christina Koukol | Pharmacist | 609 N Spring St, Beaver Dam, WI 53916-2040 | 2015-09-21 |
| 1669811857 | Larry A Day | Pharmacist | 609 N Spring St, Beaver Dam, WI 53916-2040 | 2013-06-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538718283 | Paulette Neibauer | Technician | N7262 Farwell Rd., Beaver Dam, WI 53916 | 2019-09-05 |
| 1902336597 | Tricounty Homecare Inc | In Home Supportive Care | 140 Corporate Dr Ste 2, Beaver Dam, WI 53916 | 2017-06-15 |
| 1528502754 | Jessica Marie Blatz | Counselor | 809 Park Aveune, Beaver Dam, WI 53916 | 2016-12-07 |
| 1376090886 | Beaver Dam Hearing Care, LLC | Hearing Aid Equipment | 705 University Ave, Suite 170, Beaver Dam, WI 53916 | 2016-09-01 |
| 1275902546 | Beaver Dam Community Hospitals Inc | Pharmacy | 705 S University Ave Ste 180, Beaver Dam, WI 53916 | 2015-09-17 |
| 1609242825 | Tami Joe Delisle | Counselor | 207 North Spring Street, Beaver Dam, WI 53916 | 2015-08-12 |
| 1366833394 | Beaver Dam Community Hospitals, Inc | Surgery | 705 S University Ave Ste 350, Beaver Dam, WI 53916 | 2015-02-12 |
| 1326471608 | Raquel Rodriguez-guzman | Pharmacist | 205 La Crosse Street, Beaver Dam, WI 53916 | 2013-08-09 |
| 1558608828 | Mary Y Kunz | Licensed Practical Nurse | 6550 N Highway 151 Lot 63, Beaverdam, WI 53916 | 2013-01-07 |
| 1881938454 | Brock Holden Slinger | Physical Therapist | 205 Monroe St. #13, Beaver Dam, WI 53916 | 2012-11-20 |
| Find all providers in zip 53916 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275902546 | Beaver Dam Community Hospitals Inc | Pharmacy | 705 S University Ave Ste 180, Beaver Dam, WI 53916 | 2015-09-17 |
| 1124033758 | Marshland Pharmacies Inc | Pharmacy | 705 S University Ave, Beaver Dam, WI 53916-3053 | 2006-07-30 |
| 1295771780 | Beaver Dam Community Hospitals Inc | Pharmacy | 707 S University Ave, Beaver Dam, WI 53916 | 2006-06-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497355002 | Long Life Pharmacy 2 LLC | Pharmacy | 1225 W Historic Mitchell St Ste 217, Milwaukee, WI 53204-3382 | 2020-11-01 |
| 1710527783 | Sage Specialty Pharmacy Inc. | Pharmacy | 4001 N. Oakland Ave, Shorewood, WI 53211 | 2020-01-08 |
| 1790333623 | Froedtert Health Pharmacy LLC | Pharmacy | 9200 W Wisconsin Ave Ste 200w, Milwaukee, WI 53226-3522 | 2019-09-04 |
| 1225686405 | Froedtert Health Pharmacy LLC | Pharmacy | 9200 W Wisconsin Ave Ste 200c, Milwaukee, WI 53226-3522 | 2019-08-30 |
| 1134777337 | Froedtert Health Pharmacy LLC | Pharmacy | 11430 N Port Washington Rd Ste 103, Mequon, WI 53092-3414 | 2019-08-30 |
| 1619524766 | University Rx LLC | Pharmacy | 133 E College Ave, Appleton, WI 54911 | 2019-08-23 |
| 1053967026 | Accurabenefits, LLC | Pharmacy | 2413 Woodland Ter, Neenah, WI 54956-4824 | 2019-08-14 |
| 1184276917 | St. Clare Health Mission Pharmacy | Pharmacy | 916 Ferry St, La Crosse, WI 54601-4717 | 2019-07-11 |
| 1851851141 | Dean Retail Services, Inc. | Pharmacy | 740 Reena Ave Ste 300, Fort Atkinson, WI 53538-3145 | 2019-03-22 |
| 1093287237 | Del Mar Pharmacy Sc | Pharmacy | 1000 S Cesar E Chavez Dr, Milwaukee, WI 53204-2203 | 2018-12-28 |
| Find all providers with the same taxonomy | ||||
| City | BEAVER DAM |
| Zip Code | 53916 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.