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Organization
ROUNDY'S SUPERMARKETS INC
Active
Organization
ROUNDY'S SUPERMARKETS INC
Active
Other names
Mariano's Pharmacy #544
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON BREDESTEGE (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
105 NORTHWEST HWY, CRYSTAL LAKE, IL 60014-7951
(815) 261-4733
Mailing address
PO BOX 842772, BOSTON, MA 02284-2772
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Enumeration date
01/29/2018
Last updated
01/29/2018
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