Provider Demographics
NPI:1669885471
Name:WAUWATOSA PRESCRIPTION CENTER, INC.
Entity type:Organization
Organization Name:WAUWATOSA PRESCRIPTION CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:414-266-1894
Practice Address - Street 1:4855 S MOORLAND ROAD
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151
Practice Address - Country:US
Practice Address - Phone:262-432-7613
Practice Address - Fax:414-266-1894
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAUWATOSA PRESCRIPTION CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-09
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy