Organization
OMNICARE PHARMACY INC
Active
Other names
Omni Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER SHISTER (PRESIDENT)
(414) 737-9585
Entity
Organization
Contact information
Practice address
1134 W NORTH AVE, MILWAUKEE, WI 53205-1333
(414) 727-3005
Mailing address
5335 W RIVER TRAIL RD, MEQUON, WI 53092-4876
(414) 333-2478
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9121-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2135044
PK
—
Enumeration date
05/04/2012
Last updated
12/01/2016
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