Healthcare Provider Details

I. General information

NPI: 1255895470
Provider Name (Legal Business Name): ASCENSION WISCONSIN PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 S ONEIDA ST
APPLETON WI
54915-1305
US

IV. Provider business mailing address

5000 W CHAMBERS ST RM 115
MILWAUKEE WI
53210-1650
US

V. Phone/Fax

Practice location:
  • Phone: 920-831-8467
  • Fax: 920-831-8499
Mailing address:
  • Phone: 414-874-1035
  • Fax: 414-874-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL R TORHORST
Title or Position: DIRECTOR
Credential: RPH
Phone: 262-687-2161