MEDICARE: ASCENSION WISCONSIN PHARMACY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	829242	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2110069	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013984194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENSION WISCONSIN PHARMACY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 860011
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55486-0011
Country	:	US
Telephone Number	:	414-281-7500
Fax Number	:	414-282-8610

Provider Business Practice Location Address
First Line	:	7400 W RAWSON AVE STE 140
Second Line	:
City	:	FRANKLIN
State	:	WI
Zip	:	53132-8281
Country	:	US
Telephone Number	:	414-281-7500
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KRISTOPHER CYR
Credential	:
Telephone Number	:	262-687-2151

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	12/18/2024

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