Community Memorial Hospital of Menomonee Falls Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

9462-42 Issued in WI

Legal business name

COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS INC

Practice address

7901 S 6TH St
Oak Creek, WI 53154-2010

Phone

(414) 346-8050

Fax

(262) 532-5105

NPI assigned

Sep 13, 2017

Organization subpart

No

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

Authorized official

Name

Kevin Perhach

Title

Business Manager

Phone

(262) 532-5163

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• F & MCW Drexel Town Square Pharmacy Doing business as

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

{
    "created_epoch": "1505260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1811416639",
    "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": "530512102",
            "telephone_number": "262-532-5163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7901 S 6TH ST",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531542010",
            "telephone_number": "414-346-8050",
            "fax_number": "262-532-5105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-13",
        "last_updated": "2018-07-19",
        "status": "A",
        "authorized_official_last_name": "PERHACH",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "262-532-5163"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "9462-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811416639",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2171439",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "F & MCW Drexel Town Square Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Irina Ciubotaru, MD
• Leslie A. Clark, LPC, CSAC, CIR, ICS-
• Richard V Colan, M.D.
• Comfort Care of Wi LLC
• Comfort Care of Wi LLC
• Natalie Connelly
• Jenna Nicole Cooper
• Kantrelle Damone Cooper, LPN
• Erin Anne Correll
• Adam Cosson, D.C.

• Community/Retail Pharmacy in Oak Creek, WI
• Providers in Oak Creek, 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 Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.