Provider Demographics
NPI:1518767086
Name:MABIE PHARMACY, LLC
Entity type:Organization
Organization Name:MABIE PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:MABIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-839-3335
Mailing Address - Street 1:4880 LARSON BEACH RD
Mailing Address - Street 2:
Mailing Address - City:MCFARLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53558-8724
Mailing Address - Country:US
Mailing Address - Phone:608-838-7455
Mailing Address - Fax:
Practice Address - Street 1:4880 LARSON BEACH RD
Practice Address - Street 2:
Practice Address - City:MCFARLAND
Practice Address - State:WI
Practice Address - Zip Code:53558-8724
Practice Address - Country:US
Practice Address - Phone:608-838-7455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI9484-42OtherSTATE LICENSE NUMBER