Organization
ROUNDYS SUPERMARKETS INC
Active
Other names
MARIANOS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM DOWLING (VICE PRESIDENT)
(414) 231-5000
Entity
Organization
Contact information
Practice address
1720 N MILWAUKEE AVE, VERNON HILLS, IL 60061-1538
(847) 816-3247
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
054017623
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2130170
PK
—
Enumeration date
05/06/2011
Last updated
07/11/2016
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