Provider Demographics
NPI:1497851588
Name:ROESCHEN'S HEALTHCARE LLC
Entity Type:Organization
Organization Name:ROESCHEN'S HEALTHCARE LLC
Other - Org Name:OMNICARE OF MILWAUKEE #48382
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DIRECTOR, PAYER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-770-2751
Mailing Address - Street 1:1 CVS DR
Mailing Address - Street 2:BOX 1075
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-6146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5185 S 9TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-3627
Practice Address - Country:US
Practice Address - Phone:414-486-3100
Practice Address - Fax:414-486-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
WI78470423336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33236800Medicaid
WI5119599OtherNCPDP
791870714OtherRAILROAD MEDICARE
MI5119599Medicaid
000086757OtherWPS
000086757OtherMEDICARE LOCAL
WI33236800Medicaid
0406500002Medicare NSC