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General NPI Number Information
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NPI Number | 1568799534
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Entity Type | Organization
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Legal Business Name | ROUNDYS SUPERMARKETS INC
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Dates
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Enumeration Date | 11/11/2009
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 405 N WALES RD
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City | WALES
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State | WI
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Zip | 53183-9728
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Country | US
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Telephone | 262-968-9570
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Fax | 262-968-9574
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Provider Business Mailing Address
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Address Line | PO BOX 842772
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City | BOSTON
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State | MA
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Zip | 02284-2772
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Country | US
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Telephone | 513-762-1019
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Fax | 513-762-1092
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Authorized Official
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Title or Position | MANAGER OF PHARMACY LICENSING
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Name | ALLISON BREDESTEGE
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Credential |
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Telephone | 513-762-1019
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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 | 8965-42
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License Number State | WI
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