Provider Demographics
NPI:1851939037
Name:ASCENSION WISCONSIN PHARMACY, INC
Entity Type:Organization
Organization Name:ASCENSION WISCONSIN PHARMACY, INC
Other - Org Name:ASCENSION RX 1114
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:TORHORST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-687-2161
Mailing Address - Street 1:5000 W CHAMBERS ST RM 115
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:414-874-1035
Mailing Address - Fax:414-874-1099
Practice Address - Street 1:10180 WASHINGTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53177-1604
Practice Address - Country:US
Practice Address - Phone:262-687-7555
Practice Address - Fax:262-687-7556
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASCENSION WISCONSIN PHARMACY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-18
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy