# SURETY PRO PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Surety Pro Pharmacy LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942589445
- **Authorized official:** MR. GARY P. OLSZEWSKI RPH (VICE PRESIDENT PHARMACY)
- **Authorized official phone:** (414) 433-0188

## Contact information

- **Practice address:** 9200 W LAYTON AVE, GREENFIELD, WI 53228-3348
- **Practice address phone:** (414) 433-0188
- **Practice address fax:** (414) 433-0292
- **Mailing address:** PO BOX 9830, SALT LAKE CITY, UT 84109-9830
- **Mailing address phone:** (877) 540-4748
- **Mailing address fax:** (801) 716-4872

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 9083-42 | WI | Yes |

## Other

- **Enumeration date:** 08/15/2011
- **Last updated:** 10/24/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2131230 | PK | — |