NPIMap

Organization Active NPI

Ascension Wisconsin Pharmacy, Inc

Doing business as Ascension Rx 1109

  • Community/Retail Pharmacy
  • Mequon, WI
National Provider Identifier
1306042411
Registry record updated Dec 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
ASCENSION WISCONSIN PHARMACY, INC
Doing business as
Ascension Rx 1109
Practice address
13133 N Port Washington Rd
Suite G01
Mequon, WI 53097-2419
Phone
(262) 243-6700
Fax
(262) 243-6701
NPI assigned
Jun 25, 2007
Last updated
Dec 18, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ASCENSION WISCONSIN PHARMACY, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 18, 2024

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

Authorized official

Name
Kristopher Cyr
Title
Director
Phone
(262) 687-2151

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

13133 N Port Washington Rd
Suite G01
Mequon, WI 53097-2419

Mailing address

5000 W Chambers St RM 5223
Milwaukee, WI 53210-1650
Phone (414) 874-1035

Other names 1

  • Ascension Rx 1109 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Wheaton Franciscan Healthcare-Franciscan Woods26 organizations share this tax ID, including this one
Part of
Wheaton Franciscan Healthcare-Franciscan Woods

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734480000000",
    "number": "1306042411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 W CHAMBERS ST RM 5223",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532101650",
            "telephone_number": "414-874-1035",
            "fax_number": "414-874-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13133 N PORT WASHINGTON RD",
            "address_2": "SUITE G01",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530972419",
            "telephone_number": "262-243-6700",
            "fax_number": "262-243-6701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASCENSION WISCONSIN PHARMACY, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ASCENSION WISCONSIN PHARMACY, INC",
        "enumeration_date": "2007-06-25",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A",
        "authorized_official_last_name": "CYR",
        "authorized_official_first_name": "KRISTOPHER",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "262-687-2151"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension Rx 1109",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mequon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; 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.