MEDICARE: ROUNDYS SUPERMARKETS 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	3336C0003X	Community/Retail Pharmacy	054-018203	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2140081	OTHER		PK

General Provider Information

NPI Number	:	1184068777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROUNDYS SUPERMARKETS INC

Provider Business Mailing Address
First Line	:	PO BOX 473
Second Line	:	MS-2870
City	:	MILWAUKEE
State	:	WI
Zip	:	53201-0473
Country	:	US
Telephone Number	:	414-231-5523
Fax Number	:

Provider Business Practice Location Address
First Line	:	678 N YORK ST
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-1605
Country	:	US
Telephone Number	:	630-782-0031
Fax Number	:	630-782-0048

Authorized Official
Title or Position	:	GROUP VP - LEGAL RISK & TREASU
Name	:	EDWARD KITZ
Credential	:
Telephone Number	:	414-231-5000

Provider Enumeration Date	:	04/25/2013
Last Update Date	:	09/06/2013

Similar Medicare Providers

1063840270 — DR. SUSAN E WOODEN PHARM.D.
Practice Location Address:

678 N YORK ST
ELMHURST, IL
60126-1605

Practice Phone: 630-782-0031
Practice Fax: 630-782-0048

1568588259 — ANGELO DAKLARAS PHARMD
Practice Location Address:

678 N YORK ST
ELMHURST, IL
60126-1605

Practice Phone: 630-782-0031
Practice Fax:

1013788827 — 1918 WINTER STREET OPERATING CO LLC
Practice Location Address:

678 N YORK ST
ELMHURST, IL
60126-1605

Practice Phone: 630-782-0031
Practice Fax: 630-782-0048

1437960366 — MORTEZA MODARRES MODARRES GHARAVI DR.
Practice Location Address:

2428 84TH ST
EAST ELMHURST, NY
11370-1605

Practice Phone: 917-344-9905
Practice Fax:

1114994662 — ADVOCATE HOME CARE PRODUCTS, INC
Practice Location Address:

949 N LARCH AVE
ELMHURST, IL
60126-1128

Practice Phone: 630-516-3100
Practice Fax: 630-516-3130

1043624760 — PABLO NICOLAS QUINTANA M.D.
Practice Location Address:

133 E BRUSH HILL RD
ELMHURST, IL
60126-5659

Practice Phone: 331-221-8952
Practice Fax:

Directions to “ROUNDYS SUPERMARKETS INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.