Organization
MERCY HEALTH SYSTEM CORPORATION
Active
Other names
Mercy Mall LTC Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JOAN SHADEL (DIRECTOR OF RETAIL SERVICES)
(608) 755-8787
Entity
Organization
Contact information
Practice address
1010 N WASHINGTON ST STE 107, JANESVILLE, WI 53548-1500
(608) 755-4196
(608) 755-8710
Mailing address
1010 N WASHINGTON ST, SUITE 107, JANESVILLE, WI 53548-1500
(608) 755-4196
(608) 755-8710
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
9068
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639460736
—
WI
01
—
5132597
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/22/2011
Last updated
10/12/2011
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