Wisconsin Department of Safety and Professional Services
Health & Business Renewal Application
Application Status Query
Instructions:
Please allow one hour after receipt of your status update email for the updates to be reflected in the online checklist.
Please verify the checklist information below, including your address. If your address has changed, please
e-mail
your application number, name, profession, along with your old and new address. The Credentialing department posts status information following receipt and review of application materials.
As of
:
04/12/2016
Application#
:
567137
Name
:
ENCOMPASS RX LLC
Profession
:
Pharmacy (out of state)
Address
:
ATLANTA, GA
Application Status
:
(Permanent license issued)
Requirements Not Met:
Description
Status
Comments (Please note, not all requirements will include comments)
Requirements Met:
Description
Status
Comments (Please note, not all requirements will include comments)
Type of License
Met
Application Fee
Met
$75
Applicant address of facility
Met
Mailing address until day of opening
Met
Owner Partners Corporate Officers, titles, etc
Met
Pharmacy Hours (daily)
Met
Managing Pharmacist listed and other state license number.
Met
Copy of current state license or verification letter from state board where current license is held.
Met
Wisconsin Patient Contact telephone number
Met
Managing Pharmacist/Owners Certification completed and signed.
Met
Federal Identification Number Collection
Met
4/12/2016: RECEIVED-------
3/31/2016: FEIN number was not included in the submitted application. At this time, please go to our website to obtain a copy of the application (Form #2737) – http://dsps.wi.gov. (Go to Licenses/Permits/Registrations > Health Professions > Pharmacy (Out of State) > Application Forms > Form #2737). On page 1, please complete the FEIN section, DBA name, and write your Application ID number on the form to e-mail back to us at: DSPSCredPharmacy@wi.gov. Thank you.
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