# COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Froedtert & MCW Moorland Reserve Health Center Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063874824
- **Authorized official:** KEVIN PERHACH (BUSINESS MANAGER)
- **Authorized official phone:** (414) 805-6531

## Contact information

- **Practice address:** 4805 S MOORLAND RD RM G0502A, NEW BERLIN, WI 53151-7401
- **Practice address phone:** (262) 798-7386
- **Practice address fax:** (262) 798-7320
- **Mailing address:** N86W12999 NIGHTINGALE WAY, MENOMONEE FALLS, WI 53051-2102
- **Mailing address phone:** (262) 532-5173
- **Mailing address fax:** (262) 532-5105

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0002X | Clinic Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 9396-42 | WI | Yes |

## Other

- **Enumeration date:** 03/22/2016
- **Last updated:** 07/28/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1063874824 | — | WI |
| 01 | — | 2158809 | PK | — |