Healthcare Provider Details

I. General information

NPI: 1376599886
Provider Name (Legal Business Name): JEWEL FOOD STORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N112 W 15800 MEQUON RD
GERMANTOWN WI
53022
US

IV. Provider business mailing address

N112 W 15800 MEQUON RD
GERMANTOWN WI
53022
US

V. Phone/Fax

Practice location:
  • Phone: 262-253-1526
  • Fax: 262-253-2793
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number8076
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LORENZO TORRES
Title or Position: NEW STORE ENROLLMENTS
Credential:
Phone: 847-916-4463