Provider Demographics
NPI:1669020590
Name:FROEDTERT HEALTH PHARMACY LLC
Entity Type:Organization
Organization Name:FROEDTERT HEALTH PHARMACY LLC
Other - Org Name:FROEDTERT PHARMACY 225
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC DIR FH PHARMACY SOLUTIONS
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRIZD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-532-5168
Mailing Address - Street 1:N86W12999 NIGHTINGALE WAY
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2102
Mailing Address - Country:US
Mailing Address - Phone:262-532-5163
Mailing Address - Fax:262-532-5105
Practice Address - Street 1:8900 W DOYNE AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1265
Practice Address - Country:US
Practice Address - Phone:414-805-1295
Practice Address - Fax:262-532-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy