CROSS PLAINS PHARMACY LLC
NPI: 1528173572
· CROSS PLAINS, WI 53528
· Pharmacy
· NPI assigned 08/20/2006
$534.24
Total Medicaid Paid
Provider Details
| Authorized Official | KOSTECKI, LISA (OWNER) |
| NPI Enumeration Date | 08/20/2006 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
36 |
$534.24 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0001A |
|
18 |
16 |
$534.24 |
| 91300 |
|
18 |
16 |
$0.00 |