Provider Demographics
NPI:1194227694
Name:DEAN RETAIL SERVICES, INC.
Entity Type:Organization
Organization Name:DEAN RETAIL SERVICES, INC.
Other - Org Name:SSM HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:GRINNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-260-3586
Mailing Address - Street 1:P.O. BOX 259443
Mailing Address - Street 2:ATTN: SSM HEALTH PHARMACY ADMIN
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53725-9443
Mailing Address - Country:US
Mailing Address - Phone:608-250-1450
Mailing Address - Fax:608-250-1463
Practice Address - Street 1:752 N HIGH POINT RD STE L701
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2236
Practice Address - Country:US
Practice Address - Phone:608-824-4025
Practice Address - Fax:608-824-4875
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEAN HEATLH SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-01
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9495-423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy