Organization
ASCENSION WISCONSIN PHARMACY, INC.
Active
Other names
Ascension Rx 1105
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTOPHER CYR (DIRECTOR)
(262) 687-2151
Entity
Organization
Contact information
Practice address
10101 S 27TH ST, ROOM 1005, FRANKLIN, WI 53132-7209
(414) 325-4740
(414) 325-4741
Mailing address
PO BOX 860011, MINNEAPOLIS, MN 55486-0011
(414) 325-4740
(414) 325-4741
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
882842
WI
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2111104
PK
—
05
—
36228300
—
WI
Enumeration date
04/30/2008
Last updated
12/18/2024
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