Organization
ROUNDYS SUPERMARKETS INC
Active
Other names
METRO MARKET PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON BREDESTEGE (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
17630 W BLUEMOUND RD, BROOKFIELD, WI 53045-2908
(262) 784-2490
(262) 784-2507
Mailing address
PO BOX 842772, BOSTON, MA 02284-2772
(513) 762-1019
(513) 762-1092
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8999-042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164745162
—
WI
01
—
2123938
PK
—
Enumeration date
03/04/2010
Last updated
12/01/2016
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