Roundys Supermarkets Inc
Organization Active NPI Community/Retail Pharmacy · Rothschild, WI
NPI 1306173307 · NPPES record last updated Dec 1, 2016
Key facts
- NPI
- 1306173307
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 8977-42 (WI)
- Legal business name
- ROUNDYS SUPERMARKETS INC
- Practice address
- 10101 Market St
Rothschild, WI 54474-7938 - Phone
- (715) 241-0245
- Fax
- (715) 241-1076
- NPI assigned
- Nov 11, 2009
- Organization subpart
- No
Authorized official
- Name
- Allison Bredestege
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 762-1019
Corporate family (same tax ID) 24
Member of 3
Practitioners 3
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D2156019 | Pick N Save Pharmacy #534-404 | Certificate of waiver | Oct 8, 2026 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Pick N Save Pharmacy #6404 |
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 |
| O20100930041702 | WI | DME Supplier - Pharmacy |
5698858470 | Practice locations: Rothschild, WI |
National Provider Directory
- Tax ID family
- Mariano'S Pharmacy
Locations
10101 Market St
Rothschild, WI 54474
Phone (715) 241-0245
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 8977-42 | WI | Yes |
Addresses
Primary practice location
10101 Market St
Rothschild, WI 54474-7938
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306173307 | Medicaid | WI | |
| 2122734 | Other | PK |
Other names
- PICK N SAVE PHARMACY
Other providers in Rothschild, WI
- Tara Piastowski
- Holly Purcell
- Chelsea Reed
- Riverside Fire District
- Rodney Lee Rogalla
- Rachael Schmitz
- Paul Schneck
- Michelle Shinkle
- Shopko Stores Operating Co LLC
- Shopko Stores Operating Co. LLC
All providers in Rothschild, 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.