Provider Demographics
NPI:1053415000
Name:CARDINS PHARMACY INC
Entity type:Organization
Organization Name:CARDINS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:608-348-9221
Mailing Address - Street 1:PO BOX 633
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-0633
Mailing Address - Country:US
Mailing Address - Phone:608-348-9221
Mailing Address - Fax:608-348-5016
Practice Address - Street 1:1450 EASTSIDE RD
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-9800
Practice Address - Country:US
Practice Address - Phone:608-348-9221
Practice Address - Fax:608-348-5016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X
WI8469423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5108712OtherNCPDP PROVIDER IDENTIFICATION NUMBER
WI33122000Medicaid
0643780002Medicare NSC