Provider Demographics
NPI:1932772605
Name:WAUKESHA HEALTH SYSTEM, INC
Entity Type:Organization
Organization Name:WAUKESHA HEALTH SYSTEM, INC
Other - Org Name:PROHEALTH PHARMACY-MUKWONAGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REIMBURSEMENT MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-928-4704
Mailing Address - Street 1:N17 W24100 RIVERWOOD DR.
Mailing Address - Street 2:STE. 200
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1187
Mailing Address - Country:US
Mailing Address - Phone:262-928-1000
Mailing Address - Fax:262-953-8829
Practice Address - Street 1:240 MAPLE AVE STE 1420
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-8475
Practice Address - Country:US
Practice Address - Phone:262-521-7410
Practice Address - Fax:262-953-8829
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAUKESHA HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-21
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy