Organization
ROUNDYS SUPERMARKETS INC
Active
Other names
Pick 'n Save Pharmacy #407
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON BREDESTEGE (MANAGER OF PHARMACY LICENSING)
(513) 762-1263
Entity
Organization
Contact information
Practice address
2201 MILLER PARK WAY, WEST MILWAUKEE, WI 53219-1643
(414) 231-5959
(513) 762-1019
Mailing address
PO BOX 842772, BOSTON, MA 02284-2772
(513) 762-1019
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9455-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2168793
PK
—
Enumeration date
03/01/2017
Last updated
04/25/2017
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