# ROUNDYS SUPERMARKETS INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** COPPS PHARMACY LTC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750707204
- **Authorized official:** ALLISON BREDESTEGE (MANAGER OF PHARMACY LICENSING)
- **Authorized official phone:** (513) 762-1019

## Contact information

- **Practice address:** 1542 PLOVER RD, PLOVER, WI 54467-3902
- **Practice address phone:** (715) 345-0585
- **Practice address fax:** (715) 345-0592
- **Mailing address:** PO BOX 842772, BOSTON, MA 02284-2772
- **Mailing address phone:** (513) 762-1019
- **Mailing address fax:** (513) 762-1092

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 9308-42 | WI | Yes |

## Other

- **Enumeration date:** 03/07/2014
- **Last updated:** 02/14/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2144886 | PK | — |