Provider Demographics
NPI:1730260233
Name:CHARTWELL MIDWEST WISCONSIN, LLC
Entity type:Organization
Organization Name:CHARTWELL MIDWEST WISCONSIN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-831-8555
Mailing Address - Street 1:1345 DEMING WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3688
Mailing Address - Country:US
Mailing Address - Phone:608-831-8555
Mailing Address - Fax:608-831-9747
Practice Address - Street 1:1345 DEMING WAY STE 100
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3688
Practice Address - Country:US
Practice Address - Phone:608-831-8555
Practice Address - Fax:608-831-9747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336H0001X
WI7416-0423336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3193OtherSATE OF IOWA PHARMACY LICENSE
WI5122267OtherNCPDP
WI7416-42OtherSTATE OF WI PHARMACY LICENSE
WI9616-42OtherSTATE OF WI PHARMACY LICENSE
IL054.018120OtherSTATE OF IL PHARMACY LICENSE
MN264016OtherSATE OF MN PHARMACY LICENSE
WI33202500Medicaid