Healthcare Provider Details

I. General information

NPI: 1013984194
Provider Name (Legal Business Name): ASCENSION WISCONSIN PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 W RAWSON AVE STE 140
FRANKLIN WI
53132-8281
US

IV. Provider business mailing address

PO BOX 860011
MINNEAPOLIS MN
55486-0011
US

V. Phone/Fax

Practice location:
  • Phone: 414-281-7500
  • Fax:
Mailing address:
  • Phone: 414-281-7500
  • Fax: 414-282-8610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number829242
License Number StateWI

VIII. Authorized Official

Name: KRISTOPHER CYR
Title or Position: DIRECTOR
Credential:
Phone: 262-687-2151