FROEDTERT MEMORIAL LUTHERAN HOSPITAL, INC. (NPI# 1275056723) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275056723 |
| Entity Type | Organization |
| Organization Name | FROEDTERT MEMORIAL LUTHERAN HOSPITAL, INC. |
| Other Organization Name | FROEDTERT & MCW MEQUON HEALTH CENTER REMOTE DISPENSING SITE |
| Practice Address |
11430 N Port Washington Rd Suite 103 Mequon WI 53092-3454 |
| Mailing Address |
N86 N12999 Nightingale Way Menomonee Falls WI 53051 |
| Practice Telephone | 2625181899 |
| Practice Fax Number | 2625325105 |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2019-10-18 |
| Authorized Official Name | DALE DRIZD (DIRECTOR) |
| Authorized Official Telephone | 2625325168 |
| Authorized Official Credential | PHARMD |
| Is Organization Subpart | Y |
| Parent Organization Name | FROEDTERT MEMORIAL LUTHERAN HOSPITAL, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| Other Name | Type Code |
|---|---|
| Froedtert & MCW Mequon Health Center Remote Dispensing Site | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255334173 | Froedtert Memorial Lutheran Hospital, Inc. | General Acute Care Hospital | 9200 W Wisconsin Ave, Milwaukee, WI 53226-3522 | 2005-05-24 |
| 1356722045 | Froedtert Memorial Lutheran Hospital, Inc. | Pharmacy | 9200 W Wisconsin Ave, Cfac Pharmacy, Milwaukee, WI 53226-3522 | 2015-06-18 |
| 1841627015 | Froedtert Memorial Lutheran Hospital, Inc. | Pharmacy | 925 N 87th St, Milwaukee, WI 53226-4812 | 2013-10-03 |
| 1457604928 | Froedtert Memorial Lutheran Hospital, Inc. | Pharmacy | W180n8000 Town Hall Rd, Menomonee Falls, WI 53051-4002 | 2012-10-22 |
| 1154597292 | Froedtert Memorial Lutheran Hospital, Inc. | Pharmacy | 9200 W Wisconsin Ave, Ste 200c, Milwaukee, WI 53226-3522 | 2008-05-07 |
| 1861573446 | Froedtert Memorial Lutheran Hospital, Inc. | Pharmacy | 9200 W Wisconsin Ave, Suite 100e, Milwaukee, WI 53226-3522 | 2006-10-18 |
| 1881783777 | Froedtert Memorial Lutheran Hospital, Inc. | Pharmacy | 9200 W Wisconsin Ave, Suite 200w, Milwaukee, WI 53226-3522 | 2006-10-11 |
| 1003819475 | Froedtert Memorial Lutheran Hospital, Inc. | Rehabilitation Unit | 9200 W Wisconsin Ave, Milwaukee, WI 53226-3522 | 2005-05-31 |
| 1982607354 | Froedtert Memorial Lutheran Hospital, Inc. | Durable Medical Equipment & Medical Supplies | 9200 W Wisconsin Ave, Milwaukee, WI 53226-3522 | 2005-05-31 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | FROEDTERT MEMORIAL LUTHERAN HOSPITAL, INC. | 9200 W Wisconsin Ave, Milwaukee, WI 53226-3522 |
| Street Address |
11430 N PORT WASHINGTON RD SUITE 103 |
| City | MEQUON |
| State | WI |
| Zip Code | 53092-3454 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598742652 | Michael Gerard | Family Medicine | 11430 N Port Washington Rd, Mequon, WI 53092-3414 | 2005-12-29 |
| 1255577862 | Angela Petrie | Emergency Medicine | 11430 N Port Washington Rd, Mequon, WI 53092-3414 | 2009-01-02 |
| 1912126418 | Debra Greenspan Conley | Physician Assistant | 11430 N Port Washington Rd, Mequon, WI 53092-3414 | 2007-04-24 |
| 1043437213 | Bridgett R Moss | Emergency Medicine | 11430 N Port Washington Rd, Mequon, WI 53092-3414 | 2007-04-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942790761 | Kathryn Mueller | Specialist/Technologist | 117 Linden Lane, Apt 7, Thiensville, WI 53092 | 2018-05-17 |
| 1427547082 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 10996 N Port Washington Rd, Mequon, WI 53092 | 2018-05-08 |
| 1912437252 | Froedtert & The Medical College of Wisconsin Community Physicians Inc | Durable Medical Equipment & Medical Supplies | 11430 Port Washington Road, Mequon, WI 53092 | 2017-06-19 |
| 1629437256 | Sean S Tsang | Acupuncturist | 909 W. Mequon Rd., Mequon, WI 53092 | 2016-02-10 |
| 1497128433 | Nancy Snoots | Counselor | 4430 W Tarrytown Ln, Mequon, WI 53092 | 2015-11-12 |
| 1609265214 | Evan Guettel | Physical Therapist | 11363 N. Port Washington Road, Mequon, WI 53092 | 2015-01-20 |
| 1881091148 | Sarah Krueger | Counselor | 216 N Green Bay Rd Suite 108, Thiensville, WI 53092 | 2014-12-01 |
| 1245667088 | Lora Transportation, LLC | Non-emergency Medical Transport (VAN) | 1228 West Baldwin Crt., Mequon, WI 53092 | 2013-10-10 |
| 1710314000 | Roxxi M Davis | Social Worker | 7113 Tamarack Ct, Mequon, WI 53092 | 2013-10-01 |
| 1225473713 | Forefront Dermatology, S.c. | Dermatology | 10303 N Port Washington Rd Ste 101, Mequon, WI 53092 | 2013-05-09 |
| Find all providers in zip 53092 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| 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. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154894483 | Ascension Wisconsin Pharmacy, Inc. | Pharmacy | 13133 N Port Washington Rd Ste G101, Mequon, WI 53097-2419 | 2019-01-09 |
| 1538609292 | Mequon Family Pharmacy Inc | Pharmacy | 1424 W Mequon Rd, Mequon, WI 53092-3226 | 2017-02-28 |
| 1518262922 | Roundys Supermarkets Inc | Pharmacy | 11558 N Port Washington Rd, Mequon, WI 53092-3416 | 2011-01-14 |
| 1306042411 | Ascension Wisconsin Pharmacy, Inc | Pharmacy | 13133 N Port Washington Rd, Suite G01, Mequon, WI 53097-2419 | 2007-06-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942816939 | The Duluth Clinic, Ltd. | Pharmacy | 204 Belknap St, Ste 100, Superior, WI 54880-2964 | 2020-09-16 |
| 1902417207 | Ipack Pharmacy LLC | Pharmacy | 17000 W North Ave Ste 108w, Brookfield, WI 53005-4423 | 2020-08-11 |
| 1851939037 | Ascension Wisconsin Pharmacy, Inc | Pharmacy | 10180 Washington Ave Ste 102, Mount Pleasant, WI 53177-1604 | 2019-12-18 |
| 1558906354 | Life Change Rx 4 LLC | Pharmacy | 6300 N 76th St Ste 246, Milwaukee, WI 53218-1208 | 2019-11-15 |
| 1285278978 | Life Change Rx 3 LLC | Pharmacy | 7115 W Capitol Dr, Milwaukee, WI 53216-2051 | 2019-11-05 |
| 1295377703 | Hayat Pharmacy 21 LLC. | Pharmacy | 2333 Northwestern Ave Ste 120, Racine, WI 53404-2520 | 2019-10-16 |
| 1487296737 | Xperience Pharmacy LLC | Pharmacy | 5715 W Appleton Ave, Milwaukee, WI 53210-2250 | 2019-10-08 |
| 1962053421 | Hayat Pharmacy 19 LLC | Pharmacy | 805 W. Layton Ave. Suite A, Milwaukee, WI 53221 | 2019-09-26 |
| 1275182925 | Walgreen Co | Pharmacy | 2265 N Mayfair Rd, Wauwatosa, WI 53226-2207 | 2019-09-05 |
| 1982257200 | Hayat Pharmacy 16 LLC | Pharmacy | 603 N 36th St, Milwaukee, WI 53208-3826 | 2019-07-17 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on FROEDTERT MEMORIAL LUTHERAN HOSPITAL, INC..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.