NPIMap

Organization Active NPI

Providence Family Pharmacy LLC

  • Community/Retail Pharmacy
  • Glendale, WI
National Provider Identifier
1386190247
Registry record updated Feb 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
9428-42 Issued in WI
Legal business name
PROVIDENCE FAMILY PHARMACY LLC
Doing business as
PROVIDENCE FAMILY PHARMACY LLC
Practice address
2500 W Silver Spring Dr
Glendale, WI 53209-4218
Phone
(414) 885-0550
Fax
(414) 885-0552
NPI assigned
Aug 31, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2020

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

Authorized official

Name
Abiola Okusanya
Title
Manager
Phone
(414) 885-0550

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 9428-42 WI Primary
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

2500 W Silver Spring Dr
Glendale, WI 53209-4218

Mailing address

2500 W Silver Spring Dr
Glendale, WI 53209-4218
Phone (414) 885-0550

Other identifiers 1

IdentifierTypeStateIssuer
2163951OtherPK

Other names 1

  • PROVIDENCE FAMILY PHARMACY LLC Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1472601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582156800000",
    "number": "1386190247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 W SILVER SPRING DR",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532094218",
            "telephone_number": "414-885-0550",
            "fax_number": "414-885-0552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 W SILVER SPRING DR",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532094218",
            "telephone_number": "414-885-0550",
            "fax_number": "414-885-0552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE FAMILY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-31",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A",
        "authorized_official_last_name": "OKUSANYA",
        "authorized_official_first_name": "ABIOLA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "414-885-0550"
    },
    "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": "9428-42",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2163951",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE FAMILY PHARMACY LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PROVIDENCE FAMILY PHARMACY LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glendale, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.