Provider Demographics
NPI:1194804872
Name:RIPON DRUG MANAGEMENT ENTERPRISES INC
Entity type:Organization
Organization Name:RIPON DRUG MANAGEMENT ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DUEHRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-748-5174
Mailing Address - Street 1:328 WATSON ST
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-1517
Mailing Address - Country:US
Mailing Address - Phone:920-748-5174
Mailing Address - Fax:920-748-2066
Practice Address - Street 1:328 WATSON ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-1517
Practice Address - Country:US
Practice Address - Phone:920-748-5174
Practice Address - Fax:920-748-2066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
WI5311-423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2111798OtherPK
WI33135300Medicaid
2111798OtherPK