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General NPI Number Information
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NPI Number | 1164524567
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Entity Type | Organization
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Legal Business Name | DEAN RETAIL SERVICES INC
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 700 S PARK ST SUITE 300
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City | MADISON
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State | WI
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Zip | 53715-1830
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Country | US
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Telephone | 608-256-6465
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Fax | 608-256-6460
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Provider Business Mailing Address
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Address Line | P. O. BOX 259443 ATTN: SSM HEALTH PHARMACY ADMIN
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City | MADISON
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State | WI
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Zip | 53725-9443
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Country | US
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Telephone | 608-250-1450
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Fax | 608-824-2690
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Authorized Official
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Title or Position | VP FINANCE
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Name | AMY JO GRINNELL
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Credential |
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Telephone | 608-260-3586
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 8338-42
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License Number State | WI
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