NPIMap

Ascension Wisconsin Pharmacy, Inc.

Organization Active NPI Community/Retail Pharmacy · Milwaukee, WI

NPI 1407924129 · NPPES record last updated Dec 18, 2024

Key facts

NPI
1407924129
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
869642 (WI)
Legal business name
ASCENSION WISCONSIN PHARMACY, INC.
Practice address
3237 S 16TH St
Room 121
Milwaukee, WI 53215-4526
Phone
(414) 647-5300
Fax
(414) 647-5304
NPI assigned
Dec 1, 2006
Organization subpart
No

Authorized official

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

Other NPIs on the same Medicare enrollment 11

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

Corporate family (same tax ID) 25

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

Practitioners 2

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WI

Medicare enrollment records

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

National Provider Directory

Tax ID family
Convenant Pharmacy (26 organizations share this tax ID)

Locations

3237 S 16th St
Rm 121
Milwaukee, WI 53215
Phone (414) 647-5300

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 869642 WI Yes

Addresses

Primary practice location

3237 S 16TH St
Room 121
Milwaukee, WI 53215-4526

Mailing address

PO Box 860011
Minneapolis, MN 55486-0011
Phone (414) 647-5300

Other identifiers

IdentifierTypeStateIssuer
33294300MedicaidWI
2111001OtherPK

Other names

  • Ascension Rx 1107 Doing business as

Other providers in Milwaukee, WI

All providers in Milwaukee, WI · Community/Retail Pharmacy in Wisconsin

Sources for this page

Verify at the official NPI Registry.