Organization
ROUNDYS SUPERMARKETS INC
Active
Other names
MARIANO'S PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD KITZ (GROUP VP - LEGAL RISK & TREASU)
(414) 231-5000
Entity
Organization
Contact information
Practice address
2112 N ASHLAND AVE, CHICAGO, IL 60614
(773) 342-6680
Mailing address
PO BOX 473, MS-2870, MILWAUKEE, WI 53201-0473
(414) 231-5523
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054-018638
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2145493
PK
—
Enumeration date
04/28/2014
Last updated
09/08/2014
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