Healthcare Provider Details

I. General information

NPI: 1144159864
Provider Name (Legal Business Name): ASCENSION WISCONSIN PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 S KOELLER ST STE 1A242
OSHKOSH WI
54902-6186
US

IV. Provider business mailing address

5000 W CHAMBERS ST RM 1801
MILWAUKEE WI
53210-1650
US

V. Phone/Fax

Practice location:
  • Phone: 262-687-2151
  • Fax: 262-687-5500
Mailing address:
  • Phone: 262-687-2151
  • Fax: 262-687-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KEVIN M CASEY
Title or Position: CCO
Credential:
Phone: 414-465-3707