# AGNESIAN HEALTHCARE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SSM Health Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104891746
- **Authorized official:** AMY JO GRINNELL (FINANCE VICE PRESIDENT WI REGION)
- **Authorized official phone:** (608) 260-3586

## Contact information

- **Practice address:** 145 N MAIN ST, FOND DU LAC, WI 54935-3423
- **Practice address phone:** (920) 926-4660
- **Practice address fax:** (920) 922-5011
- **Mailing address:** 145 N MAIN ST, FOND DU LAC, WI 54935-3423
- **Mailing address phone:** (920) 921-4660
- **Mailing address fax:** (920) 922-5011

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 02/17/2006
- **Last updated:** 07/23/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100307261 | — | WI |
| 01 | — | 2109968 | PK | — |
| 05 | — | 33259200 | — | WI |