Roundys Supermarkets Inc
Organization Active NPI Community/Retail Pharmacy · Northfield, IL
NPI 1457782252 · NPPES record last updated Sep 8, 2014
Key facts
- NPI
- 1457782252
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 054-018491 (IL)
- Legal business name
- ROUNDYS SUPERMARKETS INC
- Practice address
- 1822 Willow Rd
Northfield, IL 60093-2926 - Phone
- (847) 446-4102
- Fax
- (847) 446-4610
- NPI assigned
- Dec 3, 2013
- Organization subpart
- No
Authorized official
- Name
- Edward Kitz
- Title
- Group VP - Legal Risk & Treasury
- Phone
- (414) 231-5000
Other NPIs on the same Medicare enrollment 41
Member of 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110329000044 | IL | Part B Supplier - Mass Immunization (Roster Biller Only) | 5698858470 |
41 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Skokie, IL; Harwood Heights, IL; Hoffman Estates, IL; Lake Zurich, IL; Lombard, IL; Gurnee, IL; Naperville, IL; Northbrook, IL… |
National Provider Directory
Locations
1822 Willow Rd
Northfield, IL 60093
Phone (847) 446-4102
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 054-018491 | IL | Yes |
Addresses
Primary practice location
1822 Willow Rd
Northfield, IL 60093-2926
Mailing address
PO Box 473
Ms-2870
Milwaukee, WI 53201-0473
Phone (414) 231-5523
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2143386 | Other | PK |
Other names
- MARIANO'S PHARMACY
Other providers in Northfield, IL
- Meghan Taylor Rosenzweig
- Lorna Marie Rosol
- Jonathan Ross
- Ashley Roth
- David Rothblatt
- Nathan Rouse
- Lisa Lynn Rude
- Earle W. Ruhnke Jr.
- Katherine Elizabeth Ruocco
- Haley Sachs
All providers in Northfield, IL · Community/Retail Pharmacy in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2014. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.