MEDICARE: ALLIANCE PHARMACY SERVICES

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	8210047	WI

Other Identifiers

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

General Provider Information

NPI Number	:	1891708434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE PHARMACY SERVICES

Provider Business Mailing Address
First Line	:	9301 N 76TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-1003
Country	:	US
Telephone Number	:	414-357-5104
Fax Number	:	414-357-5156

Provider Business Practice Location Address
First Line	:	9301 N 76TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-1003
Country	:	US
Telephone Number	:	414-357-5104
Fax Number	:	414-357-5156

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DENISE WASSENAAR
Credential	:
Telephone Number	:	630-986-2560

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	10/02/2008

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Directions to “ALLIANCE PHARMACY SERVICES ” Practice Location

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