Provider Demographics
NPI:1306448246
Name:CEDARBURG PRESCRIPTION CENTER, INC
Entity type:Organization
Organization Name:CEDARBURG PRESCRIPTION CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-232-4103
Mailing Address - Street 1:N54 W6135 MILL STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012
Mailing Address - Country:US
Mailing Address - Phone:262-375-0010
Mailing Address - Fax:262-375-0080
Practice Address - Street 1:N54 W6135 MILL STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012
Practice Address - Country:US
Practice Address - Phone:262-375-0010
Practice Address - Fax:262-375-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33233800Medicaid