Roundys Supermarkets Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

8943-42 Issued in WI

Legal business name

ROUNDYS SUPERMARKETS INC

Practice address

1717 N Mayfair Rd
Wauwatosa, WI 53226-3019

Phone

(414) 778-1884

Fax

(414) 778-1936

NPI assigned

Aug 28, 2009

Organization subpart

No

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

Authorized official

Name

Allison Bredestege

Title

Manager of Pharmacy Licensing

Phone

(513) 762-1019

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• PICK N SAVE PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Member of 3

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

• Roundys Supermarkets Inc

  • Community/Retail Pharmacy
  • Germantown, WI
  • NPI 1629126982

  Member Of

  NPD member
• RBF LLC

  • Community/Retail Pharmacy
  • Oakdale, MN
  • NPI 1639227994

  Member Of

  NPD member
• The Kroger Co

  • Community/Retail Pharmacy
  • Woodstock, GA
  • NPI 1720012560

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christopher O Ukah, RPH

  • Pharmacist
  • Wauwatosa, WI
  • NPI 1396136784
  NPD (past)

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

{
    "created_epoch": "1251417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480550400000",
    "number": "1255564993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 842772",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022842772",
            "telephone_number": "513-762-1019",
            "fax_number": "513-762-1092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 N MAYFAIR RD",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532263019",
            "telephone_number": "414-778-1884",
            "fax_number": "414-778-1936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROUNDYS SUPERMARKETS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-28",
        "last_updated": "2016-12-01",
        "status": "A",
        "authorized_official_last_name": "BREDESTEGE",
        "authorized_official_first_name": "ALLISON",
        "authorized_official_title_or_position": "MANAGER OF PHARMACY LICENSING",
        "authorized_official_telephone_number": "513-762-1019"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "8943-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255564993",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2121742",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PICK N SAVE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• George Eugene Rooney Jr., DDS
• Megan M Rorabeck, DPT
• Zachary Fredric Rosen, DMD
• Alex Rosencutter
• Gretchen Roth, MD
• Roundys Supermarkets Inc
• Justin Alan Rountree, MD
• Michele Roush, DNP, PMHNP-BC
• Katherine Rowland, APNP
• Madeline Roznos, BCBA

• Community/Retail Pharmacy in Wauwatosa, WI
• Providers in Wauwatosa, WI by specialty
• Community/Retail Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2016; 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.