Healthcare Provider Details

I. General information

NPI: 1730627894
Provider Name (Legal Business Name): COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N86W12999 NIGHTINGALE WAY
MENOMONEE FALLS WI
53051-2102
US

IV. Provider business mailing address

N86W12999 NIGHTINGALE WAY
MENOMONEE FALLS WI
53051-2102
US

V. Phone/Fax

Practice location:
  • Phone: 262-532-5124
  • Fax: 262-532-5114
Mailing address:
  • Phone: 262-532-5124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number9406-42
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number9406-42
License Number StateWI

VIII. Authorized Official

Name: DALE DRIZD
Title or Position: PHARMACY DIRECTOR
Credential:
Phone: 262-532-5168