Organization
ROUNDYS SUPERMARKETS INC
Active
Other names
COPPS FOOD CENTER 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
3256 CHURCH ST, STEVENS POINT, WI 54481-5321
(715) 344-6910
(715) 344-2781
Mailing address
PO BOX 473, MS-2870, MILWAUKEE, WI 53201-0473
(414) 231-6153
(414) 231-5500
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
8983-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710214713
—
WI
01
—
5131999
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/11/2009
Last updated
04/07/2011
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