Provider Demographics
NPI:1902962889
Name:PHARMACARE LTD
Entity Type:Organization
Organization Name:PHARMACARE LTD
Other - Org Name:KONSELLA HEALTH MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-833-6770
Mailing Address - Street 1:212 BAY STREET
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-2491
Mailing Address - Country:US
Mailing Address - Phone:715-723-9177
Mailing Address - Fax:
Practice Address - Street 1:212 BAY STREET
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-2491
Practice Address - Country:US
Practice Address - Phone:715-723-9177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5103356OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WI36222000Medicaid
WI4657630010Medicare NSC
5103356OtherOTHER ID NUMBER