ROUNDYS SUPERMARKETS INC NPI 1285912394

NPI Information

  • NPI: 1285912394
  • Provider Name: ROUNDYS SUPERMARKETS INC
  • Classification: Pharmacy - 3336C0003X
  • Specialization: Community/Retail Pharmacy
  • Entity Type: Organization
  • :
  • CLIA Number: 52D2168426
  • Address: 2820 S GREEN BAY RD
    MOUNT PLEASANT, WI
    ZIP 53406
  • Phone: (262) 554-1116

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NPI Details

ROUNDYS SUPERMARKETS INC is a community/retail pharmacy pharmacy in Mount Pleasant, 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 1285912394. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

2820 S GREEN BAY RD
MOUNT PLEASANT, WI
ZIP 53406-950
Phone: (262) 554-1116
Fax: (262) 554-1162

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 52D2168426 - other - pharmacy with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count (HCPCS:K1034)
  • Administration of influenza virus vaccine (HCPCS:G0008)
  • Fee covid-19 vac 13 res (HCPCS:0124A)
  • Influenza vaccine split virus, preservative free (HCPCS:90662)
  • Adm sarscv2 30mcg trs-sucr b (HCPCS:0054A)

The enumeration date for this NPI number is 7/25/2011 and was last updated on 9/19/2025.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
13336C0003XPharmacyCommunity/Retail Pharmacy9092-42WISCONSINYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11285912394MEDICAIDWISCONSIN
22131182OTHERPK

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: 11/21/2025

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