Organization
ROUNDYS SUPERMARKETS INC
Active
Other names
COPPS PHARMACY LTC
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON BREDESTEGE (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
1542 PLOVER RD, PLOVER, WI 54467-3902
(715) 345-0585
(715) 345-0592
Mailing address
PO BOX 842772, BOSTON, MA 02284-2772
(513) 762-1019
(513) 762-1092
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9308-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2144886
PK
—
Enumeration date
03/07/2014
Last updated
02/14/2017
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