# ROUNDYS SUPERMARKETS INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pick 'n Save Pharmacy \#407
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124568894
- **Authorized official:** ALLISON BREDESTEGE (MANAGER OF PHARMACY LICENSING)
- **Authorized official phone:** (513) 762-1263

## Contact information

- **Practice address:** 2201 MILLER PARK WAY, WEST MILWAUKEE, WI 53219-1643
- **Practice address phone:** (414) 231-5959
- **Practice address fax:** (513) 762-1019
- **Mailing address:** PO BOX 842772, BOSTON, MA 02284-2772
- **Mailing address phone:** (513) 762-1019

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 9455-42 | WI | Yes |

## Other

- **Enumeration date:** 03/01/2017
- **Last updated:** 04/25/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2168793 | PK | — |