Healthcare Provider Details

I. General information

NPI: 1497303325
Provider Name (Legal Business Name): FROEDTERT HEALTH PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 N 87TH ST
MILWAUKEE WI
53226-4812
US

IV. Provider business mailing address

N86W12999 NIGHTINGALE WAY
MENOMONEE FALLS WI
53051-2102
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-3360
  • Fax: 262-532-5105
Mailing address:
  • Phone: 262-532-5163
  • Fax: 262-532-5105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KEVIN PERHACH
Title or Position: BUSINESS MANAGER
Credential:
Phone: 262-532-5163