Healthcare Provider Details

I. General information

NPI: 1003926791
Provider Name (Legal Business Name): DEAN RETAIL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 FISH HATCHERY RD STE 300
MADISON WI
53715-1909
US

IV. Provider business mailing address

P.O. BOX 259443 ATTN: SSM HEALTH PHARMACY ADMIN
MADISON WI
53725-9443
US

V. Phone/Fax

Practice location:
  • Phone: 608-252-8044
  • Fax: 608-283-7325
Mailing address:
  • Phone: 608-250-1450
  • Fax: 608-824-2690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number722642
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AMY JO GRINNELL
Title or Position: VP FINANCE
Credential:
Phone: 608-260-3586