Organization
COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS INC
Active
Other names
Froedtert & MCW Moorland Reserve Health Center Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN PERHACH (BUSINESS MANAGER)
(414) 805-6531
Entity
Organization
Contact information
Practice address
4805 S MOORLAND RD RM G0502A, NEW BERLIN, WI 53151-7401
(262) 798-7386
(262) 798-7320
Mailing address
N86W12999 NIGHTINGALE WAY, MENOMONEE FALLS, WI 53051-2102
(262) 532-5173
(262) 532-5105
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9396-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063874824
—
WI
01
—
2158809
PK
—
Enumeration date
03/22/2016
Last updated
07/28/2016
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