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
11558 N PORT WASHINGTON RD, MEQUON, WI 53092-3416
(262) 241-7983
(262) 241-8231
Mailing address
PO BOX 842772, BOSTON, MA 02284-2772
(513) 762-1019
(513) 762-1092
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
9057-042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518262922
—
WI
01
—
2128505
PK
—
Enumeration date
01/14/2011
Last updated
12/01/2016
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