Healthcare Provider Details

I. General information

NPI: 1669885471
Provider Name (Legal Business Name): WAUWATOSA PRESCRIPTION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 S MOORLAND ROAD
NEW BERLIN WI
53151
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: 262-432-7613
  • Fax: 414-266-1894
Mailing address:
  • Phone: 414-266-6223
  • Fax: 414-266-1894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARC CADIEUX
Title or Position: CORPORATE VP/CFO
Credential:
Phone: 414-266-6226