Healthcare Provider Details

I. General information

NPI: 1265453229
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL OF WISCONSIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/20/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W. WISCONSIN AVE.
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

PO BOX 1997 MS 900 ROSALIE O'MEARA
MILWAUKEE WI
53201-1997
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-1893
  • Fax: 414-266-1894
Mailing address:
  • Phone: 414-266-2000
  • Fax: 414-266-1894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8244-42
License Number StateWI

VIII. Authorized Official

Name: MARC CADIEUX
Title or Position: SENIOR VICE PRESIDENT, CFO
Credential:
Phone: 414-266-6226