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Organization
ROUNDYS SUPERMARKETS INC
Active
Organization
ROUNDYS SUPERMARKETS INC
Active
Other names
METRO MARKET PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON BREDESTEGE (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
1123 N VAN BUREN ST, MILWAUKEE, WI 53202-3269
(414) 347-9219
(414) 273-8810
Mailing address
PO BOX 842772, BOSTON, MA 02284-2772
(513) 762-1019
(513) 762-1092
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
8420042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184772444
—
WI
01
—
2110210
PK
—
Enumeration date
01/05/2007
Last updated
12/01/2016
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