MENOMINEE INDIAN TRIBE OF WISCONSIN
W3275 Wolf River Road
Keshena, WI 54135
715-799-3361
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 3336C0002X | Suppliers - Pharmacy - Clinic Pharmacy | WI | 7848-042 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
32955700 | WI | MEDICAID | |
NAPB # | 5118446 | OTHER | |
DEA # | AM7763419 | OTHER |