Provider Demographics
NPI:1902990179
Name:WHEATON FRANCISCAN PHARMACY
Entity Type:Organization
Organization Name:WHEATON FRANCISCAN PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT PHARMACY SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:D
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:414-874-6217
Mailing Address - Street 1:13950 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2441
Mailing Address - Country:US
Mailing Address - Phone:414-874-6200
Mailing Address - Fax:414-874-6215
Practice Address - Street 1:13950 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2441
Practice Address - Country:US
Practice Address - Phone:414-874-6200
Practice Address - Fax:414-874-6215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9028-0423336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33063600Medicaid