# ROUNDYS SUPERMARKETS INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MARIANO'S PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154758837
- **Authorized official:** EDWARD KITZ (GROUP VP - LEGAL, RISK & TREAS)
- **Authorized official phone:** (414) 231-5000

## Contact information

- **Practice address:** 625 S MAIN ST, WHEATON, IL 60187-5240
- **Practice address phone:** (630) 690-6474
- **Practice address fax:** (630) 690-6567
- **Mailing address:** PO BOX 473, MS-2870, MILWAUKEE, WI 53201-0473
- **Mailing address phone:** (414) 231-6153

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 054.018304 | IL | Yes |

## Other

- **Enumeration date:** 09/26/2013
- **Last updated:** 08/18/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2142284 | PK | — |