NPIMap

Organization Active NPI

Roundy's Supermarkets Inc

Doing business as Pick 'N Save Pharmacy #6390

  • Pharmacy
  • Stoughton, WI
National Provider Identifier
1245495480
Registry record updated Mar 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
8850-42 Issued in WI
Legal business name
ROUNDY'S SUPERMARKETS INC
Doing business as
Pick 'N Save Pharmacy #6390
Practice address
1750 Hwy 51 W
Stoughton, WI 53589
Phone
(608) 873-3069
Fax
(608) 873-3412
NPI assigned
Jul 28, 2008
Last updated
Mar 15, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2010

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

Authorized official

Name
Edward George Kitz
Title
GVP-Legal Risk & Treasury
Phone
(414) 231-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 8850-42 WI Primary

Addresses

Primary practice location

1750 Hwy 51 W
Stoughton, WI 53589

Mailing address

1750 Hwy 51 W
Stoughton, WI 53589
Phone (608) 873-3069

Other identifiers 2

IdentifierTypeStateIssuer
36229400MedicaidWI
5130860OtherNCPDP

Other names 1

  • PICK 'N SAVE PHARMACY #6390 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080218000141 WI Part B Supplier - Mass Immunization (Roster Biller Only) 5698858470 This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1217203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268611200000",
    "number": "1245495480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 HWY 51 W",
            "city": "STOUGHTON",
            "state": "WI",
            "postal_code": "53589",
            "telephone_number": "608-873-3069",
            "fax_number": "608-873-3412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 HWY 51 W",
            "city": "STOUGHTON",
            "state": "WI",
            "postal_code": "53589",
            "telephone_number": "608-873-3069",
            "fax_number": "608-873-3412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROUNDY'S SUPERMARKETS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-28",
        "last_updated": "2010-03-15",
        "status": "A",
        "authorized_official_last_name": "KITZ",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "GVP-LEGAL RISK & TREASURY",
        "authorized_official_telephone_number": "414-231-5000"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WI",
            "license": "8850-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36229400",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "5130860",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PICK 'N SAVE PHARMACY #6390",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stoughton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.