Organization
ROUNDYS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN JAY LINCOLN R.PH (STAFF PHARMACIST)
(262) 567-7938
Entity
Organization
Contact information
Practice address
36903 E WISCONSIN AVE, OCONOMOWOC, WI 53066-3144
(262) 567-7938
(262) 567-7994
Mailing address
36903 E WISCONSIN AVE, OCONOMOWOC, WI 53066-3144
(262) 567-7938
(262) 567-7994
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
R9740-40
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36229900
—
WI
Enumeration date
12/09/2015
Last updated
12/09/2015
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