# MERCY HEALTH SYSTEM CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mercy Mall LTC Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639460736
- **Authorized official:** JOAN SHADEL (DIRECTOR OF RETAIL SERVICES)
- **Authorized official phone:** (608) 755-8787

## Contact information

- **Practice address:** 1010 N WASHINGTON ST STE 107, JANESVILLE, WI 53548-1500
- **Practice address phone:** (608) 755-4196
- **Practice address fax:** (608) 755-8710
- **Mailing address:** 1010 N WASHINGTON ST, SUITE 107, JANESVILLE, WI 53548-1500
- **Mailing address phone:** (608) 755-4196
- **Mailing address fax:** (608) 755-8710

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | 9068 | WI | Yes |

## Other

- **Enumeration date:** 04/22/2011
- **Last updated:** 10/12/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1639460736 | — | WI |
| 01 | — | 5132597 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |