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Provider Information for 1780794479


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DEAN RETAIL SERVICES, INC.

Other Names:  
Doing Business As: 
SSM HEALTH PHARMACY

Organization Subpart: YES

NPI: 1780794479
Last Updated: 2023-10-25
Certification Date: 2023-10-25

Details

NameValue
NPI1780794479
Enumeration Date2006-08-30
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: AMY JO GRINNELL
Title: VP FINANCE
Phone: 6082603586
Mailing Address P.O. BOX 259443
ATTN: SSM HEALTH PHARMACY ADMIN
MADISON, WI 53725-9443
United States

Phone: 608-250-1450 | Fax:608-824-2690
 
Primary Practice Address 752 N. HIGH POINT RD
SUITE 300
MADISON, WI 53717-2236
United States

Phone: 608-824-4500 | Fax:608-824-4928
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDWI33243500
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 3336C0003X - Pharmacy - Community/Retail Pharmacy