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Organization
FROEDTERT MEMORIAL LUTHERAN HOSPITAL, INC.
Active
Organization
FROEDTERT MEMORIAL LUTHERAN HOSPITAL, INC.
Active
Other names
Froedtert Outpatient West Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFERY R VAN DE KREEKE (SR. VICE PRESIDENT - FINANCE)
(414) 777-0968
Entity
Organization
Contact information
Practice address
9200 W WISCONSIN AVE, SUITE 200W, MILWAUKEE, WI 53226-3522
(414) 805-5114
(414) 805-7961
Mailing address
9200 W WISCONSIN AVE, SUITE 200W, MILWAUKEE, WI 53226-3522
(414) 805-5114
(414) 805-7961
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
3336C0002X
Clinic Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
7501-042
WI
3336S0011X
Specialty Pharmacy
—
NULL
Other
Enumeration date
10/11/2006
Last updated
05/06/2009
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