Organization
AGNESIAN HEALTHCARE INC
Active
Other names
SSM Health Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
AMY JO GRINNELL (FINANCE VICE PRESIDENT WI REGION)
(608) 260-3586
Entity
Organization
Contact information
Practice address
904 W MAIN ST, WAUPUN, WI 53963-1201
(920) 324-3010
(920) 324-3875
Mailing address
904 W MAIN ST, WAUPUN, WI 53963-1201
(920) 324-3010
(920) 324-4370
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100317609
—
WI
01
—
2113944
PK
—
05
—
33272300
—
WI
Enumeration date
02/17/2006
Last updated
07/23/2025
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