Roundy'S Supermarkets, INC
Pharmacy, Community/Retail Pharmacy in Lombard, IL. Organization (NPI-2).
NPI number1477098978
StatusActive
Last updated in NPPESDec 1, 2017
Details
- NPI
- 1477098978
- Entity type
- Organization (NPI-2)
- Legal business name
- Roundy'S Supermarkets, INC
- Organization subpart
- No
- Enumeration date
- Dec 20, 2016
- Last updated
- Dec 1, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | – | – | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – |
Other names
- Mariano'S Pharmacy #543 (Doing Business As)
Practice location
345 W Roosevelt RdLombard, IL 60148-4219
Phone 630-629-4475
Mailing address
Po Box 842772Boston, MA 02284-2772
Authorized official
Allison Bredestege
Manager Of Rx Licensing
5137621019
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