MBMC MAUSTON PHILLIPS, LLC (NPI# 1629520879) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629520879 |
| Entity Type | Organization |
| Organization Name | MBMC MAUSTON PHILLIPS, LLC |
| Other Organization Name | PHILLIPS PHARMACY |
| Practice Address |
123 E State St Mauston WI 53948-1344 |
| Practice Telephone | 6088475949 |
| Practice Fax Number | 6088475004 |
| Mailing Telephone | 6088475949 |
| Mailing Fax Number | 6088475004 |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2016-11-03 |
| Authorized Official Name | JAMES O'KEEFE (PRESIDENT & CEO) |
| Authorized Official Telephone | 6088476161 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
9434-42 | WI | Suppliers |
| Other Name | Type Code |
|---|---|
| Phillips Pharmacy | Doing Business As Name - Organization |
| Street Address |
123 E STATE ST |
| City | MAUSTON |
| State | WI |
| Zip Code | 53948-1344 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740252857 | Phillips Drug Store, Inc. | Pharmacy | 123 E State St, Mauston, WI 53948 | 2006-02-02 |
| 1700401338 | Joanna Martyna Adamski | Pharmacist | 123 E State St, Mauston, WI 53948-1344 | 2020-06-09 |
| 1649440124 | Wayne Macardy | Pharmacist | 123 E State St, Mauston, WI 53948-1344 | 2008-03-11 |
| 1205997517 | Source One Healthcare A Division of Phillips Pharmacies | Health Maintenance Organization | 123 E State St, Mauston, WI 53948-1344 | 2006-12-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114557691 | Paige Odegard | Case Manager/Care Coordinator | Juneau Co. Dept of Human Services, 200 Hickory Street, Mauston, WI 53948 | 2020-01-23 |
| 1083934418 | Brandon J Valgardson | Dentist | 880 Herriott Drive, Mauston, WI 53948 | 2010-06-08 |
| 1235451204 | Robin Adair Thompson | Dental Hygienist | 880 Herriot Drive, Mauston, WI 53948 | 2010-02-18 |
| 1114169943 | Ptworks LLC | Clinic/Center | 690 Kennedy Street, Mauston, WI 53948 | 2009-03-25 |
| 1609901529 | Mary Ann Brown | Physical Therapy Assistant | N3334 Hwy 58, Mauston, WI 53948 | 2007-02-22 |
| 1497809412 | Bobbi Eckerman | Occupational Therapist | 1050 Division St., Mauston, WI 53948 | 2007-01-23 |
| 1215092820 | Patrick Michael Mccormick | Dentist | 510 E State St, Mauston, WI 53948 | 2006-12-26 |
| 1093772287 | Ann Marie June | Social Worker | Juneau County Dept of Human Services, 200 Hickory St, Mauston, WI 53948 | 2006-05-01 |
| 1336781574 | Leah Bernadette Doughty | Physician Assistant | 1050 Division St, Urgent Care/ed, Mauston, WI 53948 | 2019-10-09 |
| 1124686514 | Mongtu Thi Ngo | Physician Assistant | 1050 Division St, Mauston, WI 53948 | 2019-05-31 |
| Find all providers in zip 53948 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| 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: new] |
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| 1295377703 | Hayat Pharmacy 21 LLC. | Pharmacy | 2333 Northwestern Ave Ste 120, Racine, WI 53404-2520 | 2019-10-16 |
| 1487296737 | Xperience Pharmacy LLC | Pharmacy | 5715 W Appleton Ave, Milwaukee, WI 53210-2250 | 2019-10-08 |
| 1962053421 | Hayat Pharmacy 19 LLC | Pharmacy | 805 W. Layton Ave. Suite A, Milwaukee, WI 53221 | 2019-09-26 |
| 1275182925 | Walgreen Co | Pharmacy | 2265 N Mayfair Rd, Wauwatosa, WI 53226-2207 | 2019-09-05 |
| 1982257200 | Hayat Pharmacy 16 LLC | Pharmacy | 603 N 36th St, Milwaukee, WI 53208-3826 | 2019-07-17 |
| Find all providers with the same taxonomy | ||||
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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.