# ROUNDYS SUPERMARKETS INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MARIANOS PHARMACY \#8536
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386002145
- **Authorized official:** EDWARD KITZ (GROUP VP - LEGAL RISK & TREASURY)
- **Authorized official phone:** (414) 231-5000

## Contact information

- **Practice address:** 150 W 63RD ST, WESTMONT, IL 60559
- **Practice address phone:** (630) 964-4654
- **Practice address fax:** (630) 964-5056
- **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 | — | NULL | Yes |

## Other

- **Enumeration date:** 02/08/2016
- **Last updated:** 02/08/2016