Active NPI
Roundys Supermarkets Inc
- Community/Retail Pharmacy
- Sheboygan, WI
National Provider Identifier
1538438502
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 9105-42
- Legal business name
- ROUNDYS SUPERMARKETS INC
- Doing business as
- PICK N SAVE PHARMACY
- Practice address
- 2625 S Business Dr
Sheboygan, WI 53081-6101 - Phone
- (920) 452-2739
- Fax
- (920) 452-2875
- NPI assigned
- Dec 21, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Allison Bredestege
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 762-1019
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 9105-42 | WI | Primary |
Addresses
Primary practice location
2625 S Business Dr
Sheboygan, WI 53081-6101
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2133237 | Other | PK |
Other names 1
- PICK N SAVE PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| 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 |
National Provider Directory
National Provider DirectoryMember of 3
Organizations this organization is a member of, according to the National Provider Directory.
Locations
2625 S Business Dr
Sheboygan, WI 53081
Phone (920) 452-2739
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- Sheboygan, WI
- NPI 1871984179
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1324425600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1480550400000",
"number": "1538438502",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 842772",
"city": "BOSTON",
"state": "MA",
"postal_code": "022842772",
"telephone_number": "513-762-1019",
"fax_number": "513-762-1092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2625 S BUSINESS DR",
"city": "SHEBOYGAN",
"state": "WI",
"postal_code": "530816101",
"telephone_number": "920-452-2739",
"fax_number": "920-452-2875"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ROUNDYS SUPERMARKETS INC",
"organizational_subpart": "NO",
"enumeration_date": "2011-12-21",
"last_updated": "2016-12-01",
"status": "A",
"authorized_official_last_name": "BREDESTEGE",
"authorized_official_first_name": "ALLISON",
"authorized_official_title_or_position": "MANAGER OF PHARMACY LICENSING",
"authorized_official_telephone_number": "513-762-1019"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "WI",
"license": "9105-42",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2133237",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "PICK N SAVE PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Sheboygan, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2016; 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.