Provider Demographics
NPI:1659357424
Name:COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC
Entity Type:Organization
Organization Name:COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC
Other - Org Name:CATHEDRAL SQUARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENNING
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:414-291-1071
Mailing Address - Street 1:732 N JACKSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4620
Mailing Address - Country:US
Mailing Address - Phone:414-277-6500
Mailing Address - Fax:
Practice Address - Street 1:732 N JACKSON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4620
Practice Address - Country:US
Practice Address - Phone:414-277-6510
Practice Address - Fax:414-224-1382
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-22
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8524-042333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33285000Medicaid