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General NPI Number Information
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NPI Number | 1396331401
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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 | 12/14/2020
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 130 CORPORATE DR STE 300
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City | BEAVER DAM
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State | WI
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Zip | 53916-3116
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Country | US
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Telephone | 920-885-8510
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Fax | 920-885-8513
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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