Organization Name:  BOSCOBEL PHARMACY, INC


Practice Location:
1028 WISCONSIN AVE  BOSCOBEL, WI 53805 US
Tel: 608-375-4466  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	3336L0003X	Suppliers Pharmacy Long Term Care Pharmacy
N	332BP3500X	Suppliers Durable Medical Equipment & Medical Supplies	WI	6474-042
N	332BX2000X	Suppliers Durable Medical Equipment & Medical Supplies	WI	6474-042
N	3336H0001X	Suppliers Pharmacy	WI	6474-042
Y	3336C0003X	Suppliers Pharmacy	WI	6474-042

Other Provider Identifiers:

Issuer	Number	State	Type
NCPDP	5105312	WI	01
	33051200	WI	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin