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Organization
METHODIST MANOR HEALTH CENTER, INC.
Active
Organization
METHODIST MANOR HEALTH CENTER, INC.
Active
Other names
Manor Pharmacy - Trinity
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES ENLUND (PRESIDENT & CEO)
(414) 607-4100
Entity
Organization
Contact information
Practice address
7300 W DEAN RD, MILWAUKEE, WI 53223-2637
(414) 371-7381
(414) 371-7525
Mailing address
3023 S 84TH ST, WEST ALLIS, WI 53227-3703
(414) 607-4100
(414) 607-4502
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
8439
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33279600
—
WI
01
—
5128120
NCPDP NUMBER
WI
01
—
8439
STATE LICENSE NUMBER
WI
Enumeration date
03/01/2006
Last updated
03/07/2023
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