Roundys Supermarkets Inc
Organization Active NPI Community/Retail Pharmacy · Brookfield, WI
NPI 1164745162 · NPPES record last updated Dec 1, 2016
Key facts
- NPI
- 1164745162
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 8999-042 (WI)
- Legal business name
- ROUNDYS SUPERMARKETS INC
- Practice address
- 17630 W Bluemound Rd
Brookfield, WI 53045-2908 - Phone
- (262) 784-2490
- Fax
- (262) 784-2507
- NPI assigned
- Mar 4, 2010
- Organization subpart
- No
Authorized official
- Name
- Allison Bredestege
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 762-1019
Corporate family (same tax ID) 22
Member of 3
Practitioners 3
-
Ronald Acker, RPH
-
Katelyn Sebald, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D2155863 | Metro Market Pharmacy #534-301 | Certificate of waiver | Oct 4, 2026 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Metro Market Pharmacy #6301 |
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 |
| O20101014000480 | WI | DME Supplier - Pharmacy |
5698858470 | Practice locations: Brookfield, WI |
National Provider Directory
- Tax ID family
- Mariano'S Pharmacy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 8999-042 | WI | Yes |
Addresses
Primary practice location
17630 W Bluemound Rd
Brookfield, WI 53045-2908
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2123938 | Other | PK | |
| 1164745162 | Medicaid | WI |
Other names
- METRO MARKET PHARMACY
Other providers in Brookfield, WI
- Ashley Ross
- Cheryl Lynn Rossebo
- Haley Ann Rought
- Roundys Supermarkets Inc
- Roundys Supermarkets Inc
- Roundys Supermarkets Inc
- Linda P. Rounseville
- Angela Roush
- Amanda Gryniewicz Rowe
- Rachel Rowell
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 1, 2016. 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.