Provider Demographics
NPI:1134142839
Name:MILWAUKEE CENTER FOR INDEPENDENCE INC
Entity Type:Organization
Organization Name:MILWAUKEE CENTER FOR INDEPENDENCE INC
Other - Org Name:WHOLE HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-937-2108
Mailing Address - Street 1:2020 W. WELLS STREET
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-2720
Mailing Address - Country:US
Mailing Address - Phone:414-476-8602
Mailing Address - Fax:414-615-0626
Practice Address - Street 1:2020 W. WELLS STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2720
Practice Address - Country:US
Practice Address - Phone:414-476-8602
Practice Address - Fax:414-615-0626
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILWAUKEE CENTER FOR INDEPENDENCE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-25
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9246-423336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145187OtherPK
WI100036982Medicaid
5569730001Medicare NSC