Provider Demographics
NPI:1891148318
Name:WEST ALLIS PRESCRIPTION CENTER INC
Entity Type:Organization
Organization Name:WEST ALLIS PRESCRIPTION CENTER INC
Other - Org Name:SKYWALK PHARMACY WEST ALLIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:CADIEUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-266-6226
Mailing Address - Street 1:PO BOX 1997
Mailing Address - Street 2:MS 900 ROSALIE O'MEARA
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53201-1997
Mailing Address - Country:US
Mailing Address - Phone:414-266-6223
Mailing Address - Fax:414-337-3338
Practice Address - Street 1:6737 W WASHINGTON AVE
Practice Address - Street 2:SUITE 1100
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214
Practice Address - Country:US
Practice Address - Phone:414-337-3333
Practice Address - Fax:414-337-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WI9416-423336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160642OtherPK