Provider Demographics
NPI:1104862697
Name:FOXRIDGE HEALTHCARE INC
Entity Type:Organization
Organization Name:FOXRIDGE HEALTHCARE INC
Other - Org Name:SENTRY DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KINNEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-896-3652
Mailing Address - Street 1:2312 W SAINT PAUL AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5942
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2312 W SAINT PAUL AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5942
Practice Address - Country:US
Practice Address - Phone:262-896-3652
Practice Address - Fax:262-896-3656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8046333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33253400Medicaid
5113333OtherOTHER ID NUMBER-COMMERCIAL NUMBER
5113333OtherOTHER ID NUMBER-COMMERCIAL NUMBER