Organization
ROUNDYS SUPERMARKETS INC
Active
Other names
MARIANOS FRESH MARKET PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD KITZ (GVP - LEGAL RISK & TREASURY)
(414) 231-5000
Entity
Organization
Contact information
Practice address
802 E NORTHWEST HWY, ARLINGTON HEIGHTS, IL 60004-6233
(847) 253-5494
(847) 253-5498
Mailing address
PO BOX 473, MS-2870, MILWAUKEE, WI 53201-0473
(414) 231-6153
(414) 231-5500
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054-017351
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1484269
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/09/2010
Last updated
03/25/2013
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