Cedarburg Prescription Center Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH29535 Issued in FL

Legal business name

CEDARBURG PRESCRIPTION CENTER INC

Doing business as

North Shore Pharmacy
Ye Olde Pharmacy and Wellness Center

Practice address

N54W6135 Mill St
Ste 300
Cedarburg, WI 53012-2021

Phone

(262) 375-0010

Fax

(262) 375-0080

NPI assigned

Sep 6, 2006

Last updated

Mar 20, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kyle Beyer

Title

Owner

Phone

(414) 232-4103

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 2

• North Shore Pharmacy Doing business as
• YE OLDE PHARMACY AND WELLNESS CENTER Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rachel Erin Anderson, PHARMD

  • Pharmacist
  • Cedarburg, WI
  • NPI 1003417460
  NPD (past)
• John Richard Jankowski, R.PH.

  • Pharmacist
  • Cedarburg, WI
  • NPI 1689789075
  NPD (past)
• Valerie Klippel

  • Pharmacist
  • Cedarburg, WI
  • NPI 1750214086
  NPD (past)
• Susan Elaine Miazga, RPH

  • Pharmacist
  • Cedarburg, WI
  • NPI 1710231659
  NPD (past)
• Matthew James Paul, RPH

  • Pharmacist
  • Cedarburg, WI
  • NPI 1558615476
  NPD (past)
• Michael Vineburg, PHARMD

  • Pharmacist
  • Cedarburg, WI
  • NPI 1265038012
  NPD (past)

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679270400000",
    "number": "1730282880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N54W6135 MILL ST",
            "address_2": "STE 300",
            "city": "CEDARBURG",
            "state": "WI",
            "postal_code": "530122021",
            "telephone_number": "262-375-0010",
            "fax_number": "262-375-0080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N54W6135 MILL ST",
            "address_2": "STE 300",
            "city": "CEDARBURG",
            "state": "WI",
            "postal_code": "530122021",
            "telephone_number": "262-375-0010",
            "fax_number": "262-375-0080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDARBURG PRESCRIPTION CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-06",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A",
        "authorized_official_last_name": "BEYER",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-232-4103"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IL",
            "license": "054.018973",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KS",
            "license": "22-44771",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "7808-42",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH29535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2108915",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33233800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Shore Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "YE OLDE PHARMACY AND WELLNESS CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Cedarburg Prescription Center, Inc (LTC North Shore Pharmacy & Compounding Center)
• Cedarburg School District
• Catherine Charlton, D.C.
• M Thomas Chemotti, M.D.
• Gregory A Cherbukovsky, P.T.A.

• Community/Retail Pharmacy in Cedarburg, WI
• Providers in Cedarburg, WI by specialty
• Community/Retail Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; 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.