1053587055 NPI number — ASCENSION WISCONSIN PHARMACY, INC.

Table of content: (NPI 1053587055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053587055 NPI number — ASCENSION WISCONSIN PHARMACY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASCENSION WISCONSIN PHARMACY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053587055
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 860011
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55486-0011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-325-4740
Provider Business Mailing Address Fax Number:
414-325-4741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10101 S 27TH ST
Provider Second Line Business Practice Location Address:
ROOM 1005
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53132-7209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-325-4740
Provider Business Practice Location Address Fax Number:
414-325-4741
Provider Enumeration Date:
04/30/2008

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 882842 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 36228300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2111104 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com