Roundys Supermarkets Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

9308-42 Issued in WI

Legal business name

ROUNDYS SUPERMARKETS INC

Doing business as

Copps Pharmacy LTC

Practice address

1542 Plover Rd
Plover, WI 54467-3902

Phone

(715) 345-0585

Fax

(715) 345-0592

NPI assigned

Mar 7, 2014

Last updated

Feb 14, 2017By 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

Allison Bredestege

Title

Manager of Pharmacy Licensing

Phone

(513) 762-1019

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• COPPS PHARMACY LTC Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Member of 3

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

• Roundys Supermarkets Inc

  dba Pick N Save Pharmacy

  • Community/Retail Pharmacy
  • Germantown, WI
  • NPI 1629126982

  Member Of

  NPD member
• RBF LLC

  dba Rainbow Pharmacy

  • Community/Retail Pharmacy
  • Minneapolis, MN
  • NPI 1558419812

  Member Of

  NPD member
• The Kroger Co

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • Pickerington, OH
  • NPI 1245255967

  Member Of

  NPD member

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

{
    "created_epoch": "1394150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487030400000",
    "number": "1750707204",
    "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": "1542 PLOVER RD",
            "city": "PLOVER",
            "state": "WI",
            "postal_code": "544673902",
            "telephone_number": "715-345-0585",
            "fax_number": "715-345-0592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROUNDYS SUPERMARKETS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-07",
        "last_updated": "2017-02-14",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "9308-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2144886",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COPPS PHARMACY LTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shelby Lynn Reineke, M. ED., BCBA
• Michael J Reyes, D.D.S.
• Samantha Roberts, RN, BSN
• Kathleen E Ross, LCSW
• Roundys Supermarkets Inc (Copps Food Center Pharmacy)
• Kaela E Rueden, PT
• Christopher James Russell, PA-C
• Andrew Lee Rust, O.D.
• Sapient Health
• Daria Savchenkova

• Community/Retail Pharmacy in Plover, WI
• Providers in Plover, 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 Feb 14, 2017; 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.