Provider Information for 1023449824
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ROUNDYS SUPERMARKETS INC
Other Names:Doing Business As:MARIANO'S PHARMACYOrganization Subpart: NO
NPI: 1023449824
Last Updated: 2014-09-08
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Details
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NPI | 1023449824 | ||||||||||||
Enumeration Date | 2013-12-03 | ||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||
Status | Active | ||||||||||||
Authorized Official Information | Name: EDWARD KITZ Title: GROUP VP - LEGAL RISK & TREASURY Phone: 4142315000 | ||||||||||||
Mailing Address | PO BOX 473 MS-2870 MILWAUKEE, WI 53201-0473 United States Phone: 414-231-5523 | Fax: | ||||||||||||
Primary Practice Address | 950 BROOK FOREST AVE SHOREWOOD, IL 60404-8846 United States Phone: 815-577-2747 | Fax:815-577-2751 | ||||||||||||
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