{"npi":"1588036826","type":"NPI-2","status":"active","name":{"display":"Beaver Dam Hometown Pharmacy LLC","other":[],"organization_name":"BEAVER DAM HOMETOWN PHARMACY LLC","authorised_official":"Daniel Strause"},"specialty":{"primary_taxonomy":"3336C0003X","primary_taxonomy_description":"Community/Retail Pharmacy","slug":"community-retail-pharmacy","schema_org_specialty":null,"all":[{"code":"333600000X","description":"Pharmacy","primary":false,"state":"WI","license":"9411-42"},{"code":"332B00000X","description":"Durable Medical Equipment & Medical Supplies","primary":false,"state":null,"license":null},{"code":"3336S0011X","description":"Specialty Pharmacy","primary":false,"state":null,"license":null},{"code":"3336C0003X","description":"Community/Retail Pharmacy","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"609 N SPRING ST","city":"BEAVER DAM","state":"WI","postal_code":"539162040","country_code":"US","phone":"9203561500","fax":"9203561510"},{"purpose":"MAILING","street_1":"333 LOWVILLE RD","city":"RIO","state":"WI","postal_code":"539609437","country_code":"US","phone":"9209926800","fax":"9206146100"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"100309026","state":"WI","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20151222000518","type_code":"12-73","type_desc":"PART B SUPPLIER - MASS IMMUNIZATION (ROSTER BILLER ONLY)","state":"WI","pac_id":"6002117728"},{"enrlmt_id":"O20180203000088","type_code":"30-A5","type_desc":"DME SUPPLIER - PHARMACY","state":"WI","pac_id":"6002117728"}]},"enumeration_date":"2015-10-27","last_updated":"2025-09-08","_meta":{"source":"NPPES","snapshot_date":"2025-09-08","doc_url":"https://findmynpi.com/api"}}