Provider Demographics
NPI:1225047871
Name:WHEATON FRANCISCAN HEALTHCARE PHARMACY ENT & FRANCISCAN WOODS
Entity Type:Organization
Organization Name:WHEATON FRANCISCAN HEALTHCARE PHARMACY ENT & FRANCISCAN WOODS
Other - Org Name:WHEATON FRANCISCAN INFUSION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GRESHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-535-6907
Mailing Address - Street 1:5000 W CHAMBERS ST FL 8
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1650
Mailing Address - Country:US
Mailing Address - Phone:414-874-6277
Mailing Address - Fax:
Practice Address - Street 1:5000 W CHAMBERS ST FL 8
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1650
Practice Address - Country:US
Practice Address - Phone:414-874-6240
Practice Address - Fax:414-874-6241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33147300Medicaid
WI6694210001Medicare NSC