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Organization
ROUNDYS SUPERMARKETS INC
Active
Organization
ROUNDYS SUPERMARKETS INC
Active
Other names
MARIANO'S PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD KITZ (GROUP VP - LEGAL, RISK & TREAS)
(414) 231-5000
Entity
Organization
Contact information
Practice address
21001 S LA GRANGE RD, FRANKFORT, IL 60423-2006
(815) 464-3562
(815) 464-4820
Mailing address
PO BOX 473, MS-2870, MILWAUKEE, WI 53201-0473
(414) 231-5523
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054.018169
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2138620
PK
—
Enumeration date
01/18/2013
Last updated
08/28/2013
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