Provider Demographics
NPI:1366067654
Name:DREIER PHARMACY AND GIFT SHOP INC
Entity type:Organization
Organization Name:DREIER PHARMACY AND GIFT SHOP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DREIER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:715-526-2011
Mailing Address - Street 1:117 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-2357
Mailing Address - Country:US
Mailing Address - Phone:715-526-2011
Mailing Address - Fax:715-524-6377
Practice Address - Street 1:117 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-2357
Practice Address - Country:US
Practice Address - Phone:715-526-2011
Practice Address - Fax:715-524-6377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33055100Medicaid