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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1659362101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENSION WISCONSIN PHARMACY, INC

Provider Business Mailing Address
First Line	:	5000 W CHAMBERS ST RM 5223
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-1650
Country	:	US
Telephone Number	:	414-874-1035
Fax Number	:	414-874-1099

Provider Business Practice Location Address
First Line	:	2301 N LAKE DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-4508
Country	:	US
Telephone Number	:	414-585-1303
Fax Number	:	414-585-2809

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	12/18/2024

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