AGNESIAN HEALTHCARE ENTERPRISES LLC (NPI# 1962477588) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962477588 |
| Entity Type | Organization |
| Organization Name | AGNESIAN HEALTHCARE ENTERPRISES LLC |
| Other Organization Name | AGNESIAN PHARMACY PLUS |
| Practice Address |
420 E Division St Fond Du Lac WI 54935-4560 |
| Practice Telephone | 9209268585 |
| Practice Fax Number | 9209268935 |
| Mailing Telephone | 9209268585 |
| Mailing Fax Number | 9209268935 |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2016-06-20 |
| Authorized Official Name | NANCY HYLAND (DIRECTOR RETAIL PHARMACIES) |
| Authorized Official Telephone | 9209268723 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
8107-42 | WI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 3359700 | 05 | |
| PK | 2109967 | 01 |
| Other Name | Type Code |
|---|---|
| AGNESIAN PHARMACY PLUS | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366417917 | Agnesian Healthcare Enterprises LLC | Pharmacy | 904 W Main St, Waupun, WI 53963-1201 | 2006-02-17 |
| 1912972613 | Agnesian Healthcare Enterprises LLC | Durable Medical Equipment & Medical Supplies | 307 Camelot Dr, Fond Du Lac, WI 54935-8014 | 2006-02-17 |
| 1326013962 | Agnesian Healthcare Enterprises LLC | Pharmacy | 912 S Hickory St, Fond Du Lac, WI 54935-5530 | 2006-02-17 |
| 1659346286 | Agnesian Healthcare Enterprises LLC | Pharmacy | 730 N Margaret St, Markesan, WI 53946-8688 | 2006-02-17 |
| 1174145031 | Agnesian Healthcare Enterprises LLC | Pharmacy | 904 W Main St, Waupun, WI 53963-1201 | 2020-05-14 |
| 1235519455 | Agnesian Healthcare Enterprises LLC | Pharmacy | 421 Camelot Dr, Fond Du Lac, WI 54935-8335 | 2015-06-03 |
| 1104891746 | Agnesian Healthcare Enterprises LLC | Pharmacy | 145 N Main St, Fond Du Lac, WI 54935-3423 | 2006-02-17 |
| 1184699704 | Agnesian Healthcare Enterprises LLC | Durable Medical Equipment & Medical Supplies | 239 Trowbridge Dr, Fond Du Lac, WI 54937-9180 | 2006-02-17 |
| Street Address |
420 E DIVISION ST |
| City | FOND DU LAC |
| State | WI |
| Zip Code | 54935-4560 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760489017 | Ronald Eric Lilly | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 420 E Division St, Fond Du Lac, WI 54935-4560 | 2005-07-01 |
| 1831715721 | Agnesian Healthcare Inc | Preventive Medicine | 420 E Division St, Fond Du Lac, WI 54935-4560 | 2020-06-17 |
| 1336783042 | Lisa Jo Liedke | Nurse Practitioner | 420 E Division St, Fond Du Lac, WI 54935-4560 | 2019-11-05 |
| 1932740495 | Terrina Kay Goeden | Nurse Practitioner | 420 E Division St, Fond Du Lac, WI 54935-4560 | 2019-10-04 |
| 1801441910 | Courtney M Yenter | Nurse Practitioner | 420 E Division St, Fond Du Lac, WI 54935-4560 | 2019-08-06 |
| 1861046591 | Kimberly Kay Hornes | Nurse Practitioner | 420 E Division St, Fond Du Lac, WI 54935-4560 | 2019-07-31 |
| 1023662459 | Domenick Tirabassi Iv | Student in an Organized Health Care Education/Training Program | 420 E Division St, Fond Du Lac, WI 54935-4560 | 2019-07-24 |
| 1497308233 | Kelly Jo Rehfeldt | Nurse Practitioner | 420 E Division St, Fond Du Lac, WI 54935-4560 | 2019-07-22 |
| 1184286411 | Carley Jo Reinke | Nurse Practitioner | 420 E Division St, Fond Du Lac, WI 54935-4560 | 2019-07-08 |
| 1255823316 | Teegan R Kraus | Physician Assistant | 420 E Division St, Fond Du Lac, WI 54935 | 2018-06-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609482249 | Keziah Sherri Love | Counselor | W390 Wi-23, Fond Du Lac, WI 54935 | 2020-09-18 |
| 1891341988 | Cynthia Louise Singleton | Nurse Practitioner | 16 E 13th St., Fond Du Lac, WI 54935 | 2019-08-14 |
| 1083183297 | Elena Alexandra Giese | Nurse Practitioner | 430 E. Division St, Fond Du Lac, WI 54935 | 2018-11-16 |
| 1669963740 | Elizabeth Anne Machi | Student in an Organized Health Care Education/Training Program | 885 Western Ave Ste 300, Fond Du Lac, WI 54935 | 2018-05-23 |
| 1184150021 | Jordan Moehn | Specialist/Technologist | 633 Prairie Pkwy, Fond Du Lac, WI 54935 | 2017-05-11 |
| 1467856336 | Chuentao Ho | Specialist/Technologist | 45 South National Ave., Fond Du Lac, WI 54935 | 2014-10-21 |
| 1437587961 | Paula Seeley | Nurse Practitioner | 63 West Pioneer Rd, Fond Du Lac, WI 54935 | 2013-10-18 |
| 1144516030 | Bonnie Kay Mallon | Registered Nurse | 118 E 9th St, Fond Du Lac, WI 54935 | 2011-06-20 |
| 1770885600 | Holly Shepard | Counselor | 23 W Scott St., Fond Du Lac, WI 54935 | 2010-11-29 |
| 1437479110 | Ruth Marie Bohn | Occupational Therapy Assistant | 244 North Macy Street, Fond Du Lac, WI 54935 | 2010-06-04 |
| Find all providers in zip 54935 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| 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. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649461252 | Walgreen Co | Pharmacy | 20 W Pioneer Rd, Fond Du Lac, WI 54935-6152 | 2007-08-08 |
| 1003838608 | Wisconsin Cvs Pharmacy LLC | Pharmacy | 485 N Rolling Meadows Dr, Fond Du Lac, WI 54937-9784 | 2006-07-24 |
| 1326013962 | Agnesian Healthcare Enterprises LLC | Pharmacy | 912 S Hickory St, Fond Du Lac, WI 54935-5530 | 2006-02-17 |
| 1518991736 | Aurora Pharmacy Inc | Pharmacy | 210 Wisconsin American Dr, Suite 240, Fond Du Lac, WI 54937-2999 | 2006-07-11 |
| 1104891746 | Agnesian Healthcare Enterprises LLC | Pharmacy | 145 N Main St, Fond Du Lac, WI 54935-3423 | 2006-02-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942816939 | The Duluth Clinic, Ltd. | Pharmacy | 204 Belknap St, Ste 100, Superior, WI 54880-2964 | 2020-09-16 |
| 1902417207 | Ipack Pharmacy LLC | Pharmacy | 17000 W North Ave Ste 108w, Brookfield, WI 53005-4423 | 2020-08-11 |
| 1851939037 | Ascension Wisconsin Pharmacy, Inc | Pharmacy | 10180 Washington Ave Ste 102, Mount Pleasant, WI 53177-1604 | 2019-12-18 |
| 1558906354 | Life Change Rx 4 LLC | Pharmacy | 6300 N 76th St Ste 246, Milwaukee, WI 53218-1208 | 2019-11-15 |
| 1285278978 | Life Change Rx 3 LLC | Pharmacy | 7115 W Capitol Dr, Milwaukee, WI 53216-2051 | 2019-11-05 |
| 1295377703 | Hayat Pharmacy 21 LLC. | Pharmacy | 2333 Northwestern Ave Ste 120, Racine, WI 53404-2520 | 2019-10-16 |
| 1487296737 | Xperience Pharmacy LLC | Pharmacy | 5715 W Appleton Ave, Milwaukee, WI 53210-2250 | 2019-10-08 |
| 1962053421 | Hayat Pharmacy 19 LLC | Pharmacy | 805 W. Layton Ave. Suite A, Milwaukee, WI 53221 | 2019-09-26 |
| 1275182925 | Walgreen Co | Pharmacy | 2265 N Mayfair Rd, Wauwatosa, WI 53226-2207 | 2019-09-05 |
| 1982257200 | Hayat Pharmacy 16 LLC | Pharmacy | 603 N 36th St, Milwaukee, WI 53208-3826 | 2019-07-17 |
| Find all providers with the same taxonomy | ||||
| City | FOND DU LAC |
| Zip Code | 54935 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.