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NPI Code Detail

MEDICARE: ROUNDYS SUPERMARKETS INC

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
13336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1659741239
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 : 414-231-6153
Fax Number :
Provider Business Practice Location Address
First Line : 1500 N CLYBOURN AVE
Second Line : #C104
City : CHICAGO
State : IL
Zip : 60610-2295
Country : US
Telephone Number : 312-475-9691
Fax Number : 312-475-9688
Authorized Official
Title or Position : VICE PRESIDENT
Name : WILLIAM DOWLING
Credential :
Telephone Number : 414-231-5000
Provider Enumeration Date : 09/25/2015
Last Update Date : 07/11/2016

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