Ascension Wisconsin Pharmacy, Inc.
Organization Active NPI Community/Retail Pharmacy · Brookfield, WI
NPI 1114994209 · NPPES record last updated Dec 18, 2024
Key facts
- NPI
- 1114994209
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 846242 (WI)
- Legal business name
- ASCENSION WISCONSIN PHARMACY, INC.
- Practice address
- 19333 W North Ave
Suite 390
Brookfield, WI 53045-4132 - Phone
- (262) 780-4430
- Fax
- (262) 780-4440
- NPI assigned
- Mar 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Kristopher Cyr
- Title
- Director
- Phone
- (262) 687-2151
Other NPIs on the same Medicare enrollment 11
Corporate family (same tax ID) 25
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110125000518 | WI | Part B Supplier - Pharmacy | 0446255459 |
11 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Wauwatosa, WI; Milwaukee, WI; Franklin, WI; Brookfield, WI; Mequon, WI |
National Provider Directory
- Tax ID family
- Convenant Pharmacy
Locations
19333 W North Ave
Ste 390
Brookfield, WI 53045
Phone (262) 780-4430
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 846242 | WI | Yes |
| Compounding Pharmacy | 3336C0004X |
Addresses
Primary practice location
19333 W North Ave
Suite 390
Brookfield, WI 53045-4132
Mailing address
PO Box 860011
Minneapolis, MN 55486-0011
Phone (262) 780-4430
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2110236 | Other | PK | |
| 33280000 | Medicaid | WI |
Other names
- Ascension Rx 1104
Other providers in Brookfield, WI
- Amanda Arneson
- Brent Wayne Arnold
- Britta Arones
- Rebecca Arrichiello
- Ascension SE Wisconsin Hospital, Inc
- Ascent Chiropractic LLC
- Dawn Ashenbrenner
- Erin Ashenhurst
- Mariam Ashraf
- Asif Iqbal MD SC
All providers in Brookfield, WI · Community/Retail Pharmacy in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.