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Organization
AGNESIAN HEALTHCARE INC
Active
Organization
AGNESIAN HEALTHCARE INC
Active
Other names
SSM Health Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
AMY JO GRINNELL (FINANCE VICE PRESIDENT WI REGION)
(608) 260-3586
Entity
Organization
Contact information
Practice address
912 S HICKORY ST, FOND DU LAC, WI 54935-5530
(920) 929-7480
(920) 929-8779
Mailing address
912 S HICKORY ST, FOND DU LAC, WI 54935-5530
(920) 929-7480
(920) 929-8779
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100321857
—
WI
01
—
2110220
PK
—
05
—
33283000
—
WI
Enumeration date
02/17/2006
Last updated
07/23/2025
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