NPIMap

Organization Active NPI

Manitowoc Pharmacies Inc

Doing business as Health Mart Manitowoc Pharmacies

  • Community/Retail Pharmacy
  • Manitowoc, WI
National Provider Identifier
1356352850
Registry record updated Dec 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
4907-42 Issued in WI
Legal business name
MANITOWOC PHARMACIES INC
Doing business as
Health Mart Manitowoc Pharmacies
Practice address
919 S 8TH St
Manitowoc, WI 54220-4504
Phone
(920) 684-6789
Fax
(920) 684-7041
NPI assigned
Aug 10, 2006
Last updated
Dec 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2023

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

Authorized official

Name
Shane ReschNPI 1578966933
Title
President
Phone
(715) 253-2164

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 4907-42 WI Primary

Addresses

Primary practice location

919 S 8TH St
Manitowoc, WI 54220-4504

Mailing address

919 S 8TH St
Manitowoc, WI 54220-4504
Phone (920) 684-6789

Other names 1

  • Health Mart Manitowoc Pharmacies Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930051354 WI DME Supplier - Pharmacy 5698892453 Practice locations: Manitowoc, WI
O20150521001478 WI Part B Supplier - Mass Immunization (Roster Biller Only) 5698892453 Practice locations: Manitowoc, WI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Manitowoc Pharmacies Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Member of 1

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

Locations

109 S Main St
Brillion, WI 54110
Phone (920) 756-2841

630 Fremont St
Kiel, WI 53042
Phone (920) 894-3141

121 N Saint Augustine St
Pulaski, WI 54162
Phone (920) 822-3011

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703030400000",
    "number": "1356352850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 S 8TH ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204504",
            "telephone_number": "920-684-6789",
            "fax_number": "920-684-7041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 S 8TH ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204504",
            "telephone_number": "920-684-6789",
            "fax_number": "920-684-7041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANITOWOC PHARMACIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A",
        "authorized_official_last_name": "RESCH",
        "authorized_official_first_name": "SHANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-253-2164"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "4907-42",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Mart Manitowoc Pharmacies",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manitowoc, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; 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.