NPIMap

Organization Active NPI

Froedtert Health Pharmacy LLC

Doing business as Froedtert Pharmacy 375

  • Community/Retail Pharmacy
  • Manitowoc, WI
National Provider Identifier
1568418929
Registry record updated Jan 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
FROEDTERT HEALTH PHARMACY LLC
Doing business as
Froedtert Pharmacy 375
Practice address
1650 S. 41St Street
Manitowoc, WI 54220
Phone
(920) 320-4400
Fax
(920) 320-5104
NPI assigned
May 26, 2006
Last updated
Jan 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2024

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

Authorized official

Name
Dale Drizd
Title
Exec Dir FH Pharmacy Solutions
Phone
(262) 532-5168

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

1650 S. 41St Street
Manitowoc, WI 54220

Mailing address

N86W12999 Nightingale Way
Menomonee Falls, WI 53051
Phone (262) 532-5173

Other names 1

  • Froedtert Pharmacy 375 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20160726000061 WI Part B Supplier - Mass Immunization (Roster Biller Only) 5193846145 Practice locations: Manitowoc, WI
O20191216000207 WI Part B Supplier - Pharmacy 0749613222 14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Manitowoc, WI; West Bend, WI; Wauwatosa, WI; Oak Creek, WI; New Berlin, WI; Milwaukee, WI; Menomonee Falls, WI; Mequon, WI
O20230414001117 WI DME Supplier - Pharmacy 0749613222 Practice locations: Manitowoc, WI

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Froedtert Health Pharmacy LLC19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Member of 1

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

Locations

1010 22nd St
Two Rivers, WI 54241
Phone (414) 793-2226

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704844800000",
    "number": "1568418929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N86W12999 NIGHTINGALE WAY",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "53051",
            "telephone_number": "262-532-5173",
            "fax_number": "262-532-5105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 S. 41ST STREET",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "54220",
            "telephone_number": "920-320-4400",
            "fax_number": "920-320-5104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FROEDTERT HEALTH PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2024-01-10",
        "certification_date": "2022-10-26",
        "status": "A",
        "authorized_official_last_name": "DRIZD",
        "authorized_official_first_name": "DALE",
        "authorized_official_title_or_position": "EXEC DIR FH PHARMACY SOLUTIONS",
        "authorized_official_telephone_number": "262-532-5168"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Froedtert Pharmacy 375",
            "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 Jan 10, 2024; 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.