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MABIE PHARMACY LLC NPI 1164932091


NPI Information

NPI: 1164932091
Provider Name: MABIE PHARMACY, LLC

Doing Business As: FORWARD PHARMACY OF DEERFIELD

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

CLIA Number: 52D2270185

Address:
10 LIBERTY ST # 106
DEERFIELD, WI
ZIP 53531
Phone: (608) 764-1500
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MABIE PHARMACY, LLC is a community/retail pharmacy pharmacy in Deerfield, WI. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. MABIE PHARMACY, LLC NPI is 1164932091. The provider is registered as an organization entity type.
The provider Is Doing Business As Forward Pharmacy Of Deerfield.

The provider's business location address is:

10 LIBERTY ST # 106
DEERFIELD, WI
ZIP 53531-458
Phone: (608) 764-1500
Fax: (608) 764-1600

The provider's authorized official is Matthew Ryan Mabie .
The authorized official title is Owner and has the following contact phone number (608) 347-5420.

The CLIA number assigned to this NPI record is 52D2270185 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/5/2017 and was last updated on 3/7/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
13336L0003XPharmacyLong Term Care Pharmacy9485-042WISCONSINNo
23336S0011XPharmacySpecialty Pharmacy9485-042WISCONSINNo
33336C0003XPharmacyCommunity/Retail Pharmacy9485-042WISCONSINYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
19485-042OTHERWISCONSINSTATE OF WISCONSIN PHARMACY LICENSE
21164932091MEDICAIDWISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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