NPI 1386190247

Providence Family Pharmacy LLC

Organisation Community/Retail Pharmacy Glendale, WI

Practice location

Address: 2500 W Silver Spring Dr, Glendale, WI 53209-4218
Phone: (414) 885-0550
Fax: (414) 885-0552

Authorised official

Name: Abiola Okusanya
Title: Manager
Phone: (414) 885-0550

Registered specialties (3)

Community/Retail Pharmacy Primary

Suppliers Taxonomy 3336C0003X Licence 9428-42 (WI)

Other Pharmacy providers in Wisconsin →

Pharmacy

Suppliers Taxonomy 333600000X

Long Term Care Pharmacy

Suppliers Taxonomy 3336L0003X

Registry record

NPI: 1386190247
Entity type: Organization
NPI issued: 31 Aug 2016
Record last updated: 20 Feb 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.