Provider Demographics
NPI:1578842811
Name:ST. JOSEPH'S COMMUNITY HOSPITAL OF WEST BEND, INC.
Entity Type:Organization
Organization Name:ST. JOSEPH'S COMMUNITY HOSPITAL OF WEST BEND, INC.
Other - Org Name:FROEDTERT HEALTH ST. JOSEPH'S HOSPITAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT DIRECTOR, PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:BINITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-805-6512
Mailing Address - Street 1:3200 PLEASANT VALLEY RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-9274
Mailing Address - Country:US
Mailing Address - Phone:414-805-5113
Mailing Address - Fax:
Practice Address - Street 1:3200 PLEASANT VALLEY RD STE 1A
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-9274
Practice Address - Country:US
Practice Address - Phone:414-805-5113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WI90810423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5132751OtherNCPDP PROVIDER IDENTIFICATION NUMBER