# ASCENSION WISCONSIN PHARMACY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ascension Rx 1105
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053587055
- **Authorized official:** KRISTOPHER CYR (DIRECTOR)
- **Authorized official phone:** (262) 687-2151

## Contact information

- **Practice address:** 10101 S 27TH ST, ROOM 1005, FRANKLIN, WI 53132-7209
- **Practice address phone:** (414) 325-4740
- **Practice address fax:** (414) 325-4741
- **Mailing address:** PO BOX 860011, MINNEAPOLIS, MN 55486-0011
- **Mailing address phone:** (414) 325-4740
- **Mailing address fax:** (414) 325-4741

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 882842 | WI | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 04/30/2008
- **Last updated:** 12/18/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2111104 | PK | — |
| 05 | — | 36228300 | — | WI |