Organization
AGNESIAN HEALTHCARE INC
Active
Other names
SSM Health Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
AMY JO GRINNELL (FINANCE VICE PRESIDENT WI REGION)
(608) 260-3586
Entity
Organization
Contact information
Practice address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8585
(920) 926-8935
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8585
(920) 926-8935
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2109967
PK
—
05
—
3359700
—
WI
Enumeration date
02/17/2006
Last updated
02/07/2025
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