Roundys Supermarkets Inc
Organization Active NPI Community/Retail Pharmacy · West Milwaukee, WI
NPI 1124568894 · NPPES record last updated Apr 25, 2017
Key facts
- NPI
- 1124568894
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 9455-42 (WI)
- Legal business name
- ROUNDYS SUPERMARKETS INC
- Practice address
- 2201 Miller Park Way
West Milwaukee, WI 53219-1643 - Phone
- (414) 231-5959
- Fax
- (513) 762-1019
- NPI assigned
- Mar 1, 2017
- Organization subpart
- No
Authorized official
- Name
- Allison Bredestege
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 762-1263
Corporate family (same tax ID) 20
Member of 3
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Roundys Supermarkets Inc |
Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers|Ostomy Supplies|Urological Supplies|Enteral Nutrients|Enteral Equipment and/or Supplies|Nebulizer Equipment a… | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080218000141 | WI | Part B Supplier - Mass Immunization (Roster Biller Only) | 5698858470 | This NPI is an additional NPI on the enrollment |
| O20170927002261 | WI | DME Supplier - Pharmacy | 5698858470 | Practice locations: West Milwaukee, WI |
National Provider Directory
- Tax ID family
- Mariano'S Pharmacy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 9455-42 | WI | Yes |
Addresses
Primary practice location
2201 Miller Park Way
West Milwaukee, WI 53219-1643
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2168793 | Other | PK |
Other names
- Pick 'n Save Pharmacy #407
Other providers in West Milwaukee, WI
- Stephanie R Reeves
- Nicole Marie Reise
- Helen Robinson
- Kristin Roguszka
- Azalia G Rosas Kontowski
- Sadi Waterstraat TR
- Christopher Sanchez
- Victoria Schaff
- Daniel G Schmidt
- Andrea Schneider
All providers in West Milwaukee, 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 Apr 25, 2017. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.