Healthcare Provider Details

I. General information

NPI: 1265052211
Provider Name (Legal Business Name): DEAN RETAIL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2020
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 INTEGRITY DR
MADISON WI
53717-1416
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: 855-847-3553
  • Fax: 855-847-3558
Mailing address:
  • Phone: 608-250-1450
  • Fax: 608-824-2690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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