Provider Demographics
NPI:1306427349
Name:PCCW LLC
Entity type:Organization
Organization Name:PCCW LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHELSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-467-8884
Mailing Address - Street 1:136 N MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1606
Mailing Address - Country:US
Mailing Address - Phone:262-429-9429
Mailing Address - Fax:262-429-9428
Practice Address - Street 1:136 N MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:THIENSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53092-1606
Practice Address - Country:US
Practice Address - Phone:262-429-9429
Practice Address - Fax:262-429-9428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy