Organization
ROUNDYS SUPERMARKETS INC
Active
Other names
MARIANO'S 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
5353 N ELSTON AVE, CHICAGO, IL 60630-1610
(773) 481-6936
(773) 481-6962
Mailing address
PO BOX 473, MILWAUKEE, WI 53201-0473
(414) 231-5523
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054018021
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2136114
PK
—
Enumeration date
07/20/2012
Last updated
05/22/2013
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