MEDICARE: UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	7046-042	WI

General Provider Information

NPI Number	:	1164592150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL

Provider Business Mailing Address
First Line	:	3351 N DOWNER AVE.
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-0000
Country	:	US
Telephone Number	:	414-229-6643
Fax Number	:	414-229-6608

Provider Business Practice Location Address
First Line	:	3351 N DOWNER AVE.
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-0000
Country	:	US
Telephone Number	:	414-229-6643
Fax Number	:	414-229-6608

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	MRS. MARYANNE WAWRZYN
Credential	:	RPH
Telephone Number	:	414-229-6643

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	11/27/2024

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