Organization
ASCENSION WISCONSIN PHARMACY, INC.
Active
Other names
Ascension Rx 1104
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTOPHER CYR (DIRECTOR)
(262) 687-2151
Entity
Organization
Contact information
Practice address
19333 W NORTH AVE, SUITE 390, BROOKFIELD, WI 53045-4132
(262) 780-4430
(262) 780-4440
Mailing address
PO BOX 860011, MINNEAPOLIS, MN 55486-0011
(262) 780-4430
(262) 780-4440
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
846242
WI
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2110236
PK
—
05
—
33280000
—
WI
Enumeration date
03/07/2006
Last updated
12/18/2024
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