MEDICARE: ROUNDYS SUPERMARKETS INC

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	3336C0003X	Community/Retail Pharmacy	054.018188	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2139244	OTHER		PK

General Provider Information

NPI Number	:	1629319488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROUNDYS SUPERMARKETS INC

Provider Business Mailing Address
First Line	:	PO BOX 473
Second Line	:	MS-2870
City	:	MILWAUKEE
State	:	WI
Zip	:	53201-0473
Country	:	US
Telephone Number	:	414-231-5523
Fax Number	:

Provider Business Practice Location Address
First Line	:	7401 W LAWRENCE AVE
Second Line	:
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706-3411
Country	:	US
Telephone Number	:	708-867-8564
Fax Number	:

Authorized Official
Title or Position	:	GROUP VP-LEGAL RISK & TREASURY
Name	:	EDWARD KITZ
Credential	:
Telephone Number	:	414-231-5000

Provider Enumeration Date	:	03/04/2013
Last Update Date	:	08/08/2013

Similar Medicare Providers

1053332254 — NORWOOD PARK FIRE PROTECTION DISTRICT
Practice Location Address:

7447 W LAWRENCE AVE
HARWOOD HEIGHTS, IL
60706-3411

Practice Phone: 708-867-5428
Practice Fax: 708-867-0955

1811386816 — MS. PATRICIA JAGELSKI RPH
Practice Location Address:

7401 W LAWRENCE AVE
HARWOOD HEIGHTS, IL
60706-3411

Practice Phone: 708-867-8564
Practice Fax: 708-867-8586

1285152314 — DR. JOHN JOSEPH PRESTIANNI III PHARM.D
Practice Location Address:

7401 W LAWRENCE AVE
HARWOOD HEIGHTS, IL
60706-3411

Practice Phone: 708-867-8564
Practice Fax:

1659866598 — MILIVOJE NEDIC
Practice Location Address:

7401 W LAWRENCE AVE
HARWOOD HEIGHTS, IL
60706-3411

Practice Phone: 708-867-8564
Practice Fax:

1477187425 — DR. TOMASZ KACZOR PHARMD
Practice Location Address:

7401 W LAWRENCE AVE
HARWOOD HEIGHTS, IL
60706-3411

Practice Phone: 708-867-8564
Practice Fax: 708-867-8586

1144336173 — ALFRED CISNEROS M.D.
Practice Location Address:

4777 N HARLEM AVE
HARWOOD HEIGHTS, IL
60706-4658

Practice Phone: 708-867-4020
Practice Fax: 708-867-5306

Directions to “ROUNDYS SUPERMARKETS INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.