Healthcare Provider Details

I. General information

NPI: 1811637127
Provider Name (Legal Business Name): FROEDTERT HEALTH PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 S 41ST ST
MANITOWOC WI
54220-7316
US

IV. Provider business mailing address

N86W12999 NIGHTINGALE WAY
MENOMONEE FALLS WI
53051-2102
US

V. Phone/Fax

Practice location:
  • Phone: 920-320-4400
  • Fax:
Mailing address:
  • Phone: 262-532-5173
  • Fax: 262-532-5105

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: DALE DRIZD
Title or Position: EXEC DIR FH PHARMACY SOLUTIONS
Credential:
Phone: 262-532-5168