Provider Type Icon

ROUNDYS SUPERMARKETS INC NPI 1164745162


NPI Information

NPI: 1164745162
Provider Name: ROUNDYS SUPERMARKETS INC

Doing Business As: METRO MARKET PHARMACY

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

CLIA Number: 52D2155863

Address:
17630 W BLUEMOUND RD
BROOKFIELD, WI
ZIP 53045
Phone: (262) 784-2490
Get Directions

ROUNDYS SUPERMARKETS INC is a community/retail pharmacy pharmacy in Brookfield, WI. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. ROUNDYS SUPERMARKETS INC NPI is 1164745162. The provider is registered as an organization entity type.
The provider Is Doing Business As Metro Market Pharmacy.

The provider's business location address is:

17630 W BLUEMOUND RD
BROOKFIELD, WI
ZIP 53045-908
Phone: (262) 784-2490
Fax: (262) 784-2507

The provider's authorized official is Allison Bredestege .
The authorized official title is Manager Of Pharmacy Licensing and has the following contact phone number (513) 762-1019.

The CLIA number assigned to this NPI record is 52D2155863 - other - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/4/2010 and was last updated on 12/1/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1333600000XPharmacyNo
23336C0003XPharmacyCommunity/Retail Pharmacy8999-042WISCONSINYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
15305720069MEDICARE NSC
22123938OTHERPK
31164745162MEDICAIDWISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.