GREEN BAY VA CBOC PHARMACY (4179)    INSTITUTION (4)

Name Value
NAME GREEN BAY VA CBOC PHARMACY
STATE WISCONSIN
STREET ADDR. 1 2851 UNIVERSITY AVE
CITY GREEN BAY
ZIP 54311-5855
OFFICIAL VA NAME GREEN BAY VA CBOC PHARMACY
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME GREEN BAY VA CLINIC PHARMACY
EFFECTIVE DATE/TIME
  • 2013-08-22 00:00:00
    STATUS:   ACTIVE
    NPI:   1780019380
TAXONOMY CODE
  • Suppliers
    PRIMARY CODE:   YES
    STATUS:   ACTIVE
LOCATION TIMEZONE CENTRAL
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA