NPIMap

Organization Active NPI

Froedtert Health Pharmacy, LLC

Doing business as Froedtert Pharmacy 400

  • Community/Retail Pharmacy
  • Wauwatosa, WI
National Provider Identifier
1083364020
Registry record updated May 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
FROEDTERT HEALTH PHARMACY, LLC
Doing business as
Froedtert Pharmacy 400
Practice address
10000 W Bluemound Rd
Wauwatosa, WI 53226-4321
Phone
(414) 454-8150
NPI assigned
Mar 24, 2022
Last updated
May 10, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2022

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

Authorized official

Name
Dale Drizd
Title
Executive Director & Coo
Phone
(262) 532-5168

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

10000 W Bluemound Rd
Wauwatosa, WI 53226-4321

Mailing address

N86W12999 Nightingale Way
Menomonee Falls, WI 53051-2102
Phone (262) 532-5173

Other names 1

  • Froedtert Pharmacy 400 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20191216000207 WI Part B Supplier - Pharmacy 0749613222 14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Manitowoc, WI; West Bend, WI; Wauwatosa, WI; Oak Creek, WI; New Berlin, WI; Milwaukee, WI; Menomonee Falls, WI; Mequon, WI
O20220805000178 WI DME Supplier - Pharmacy 0749613222 Practice locations: Wauwatosa, WI

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

Laboratory certificates & supplier records

Derived by NPIMap

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Froedtert Health Pharmacy LLC10000 W Bluemound Rd, Wauwatosa, WI 53226-4321(414) 454-8150 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Nov 3, 2019

National Provider Directory

National Provider Directory
Tax ID family
Froedtert Health Pharmacy19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1648080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652140800000",
    "number": "1083364020",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10000 W BLUEMOUND RD",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532264321",
            "telephone_number": "414-454-8150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FROEDTERT HEALTH PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-24",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A",
        "authorized_official_last_name": "DRIZD",
        "authorized_official_first_name": "DALE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR & COO",
        "authorized_official_telephone_number": "262-532-5168"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Froedtert Pharmacy 400",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Froedtert Pharmacy 400",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wauwatosa, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.