Community Memorial Hospital of Menomonee Falls Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

9396-42 Issued in WI

Legal business name

COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS INC

Practice address

4805 S Moorland Rd RM G0502A
New Berlin, WI 53151-7401

Phone

(262) 798-7386

Fax

(262) 798-7320

NPI assigned

Mar 22, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kevin Perhach

Title

Business Manager

Phone

(414) 805-6531

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Froedtert & MCW Moorland Reserve Health Center Pharmacy Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469664000000",
    "number": "1063874824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N86W12999 NIGHTINGALE WAY",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530512102",
            "telephone_number": "262-532-5173",
            "fax_number": "262-532-5105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 S MOORLAND RD RM G0502A",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531517401",
            "telephone_number": "262-798-7386",
            "fax_number": "262-798-7320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-22",
        "last_updated": "2016-07-28",
        "status": "A",
        "authorized_official_last_name": "PERHACH",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "414-805-6531"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "9396-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063874824",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2158809",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Froedtert & MCW Moorland Reserve Health Center Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jeanne E Conner, APNP
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• Maria Cook, PT

• Community/Retail Pharmacy in New Berlin, WI
• Providers in New Berlin, WI by specialty
• Community/Retail Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.