Healthcare Provider Details

I. General information

NPI: 1124098330
Provider Name (Legal Business Name): VERSITI WISCONSIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 N 18TH ST
MILWAUKEE WI
53233-2121
US

IV. Provider business mailing address

PO BOX 2178
MILWAUKEE WI
53201-2178
US

V. Phone/Fax

Practice location:
  • Phone: 414-937-6160
  • Fax: 414-933-7350
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number8375-42
License Number StateWI

VIII. Authorized Official

Name: BARTHOLOMEW REUTER
Title or Position: EVP CHIEF CORPORATE COUNSEL
Credential:
Phone: 414-937-6418