PROVIDENCE FAMILY PHARMACY LLC (NPI# 1386190247) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386190247 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE FAMILY PHARMACY LLC |
| Other Organization Name | PROVIDENCE FAMILY PHARMACY LLC |
| Practice Address |
2500 W Silver Spring Dr Glendale WI 53209-4218 |
| Practice Telephone | 4148850550 |
| Practice Fax Number | 4148850552 |
| Mailing Telephone | 4148850550 |
| Mailing Fax Number | 4148850552 |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2020-02-20 |
| Authorized Official Name | ABIOLA OKUSANYA (MANAGER) |
| Authorized Official Telephone | 4148850550 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| N | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
9428-42 | WI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2163951 | 01 |
| Other Name | Type Code |
|---|---|
| PROVIDENCE FAMILY PHARMACY LLC | Doing Business As Name - Organization |
| Street Address |
2500 W SILVER SPRING DR |
| City | GLENDALE |
| State | WI |
| Zip Code | 53209-4218 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750376091 | Jacqueline C Howell | Pediatrics | 2500 W Silver Spring Dr, Glendale, WI 53209-4218 | 2005-09-13 |
| 1861857542 | Providence Family Medical Clinic S.c | Clinic/Center | 2500 W Silver Spring Dr, Glendale, WI 53209-4218 | 2015-12-22 |
| 1417271909 | Andrew Alan Lijewski | Chiropractor | 2500 W Silver Spring Dr, Glendale, WI 53209-4218 | 2010-03-26 |
| 1134394471 | Children's Medical Group | Pediatrics | 2500 W Silver Spring Dr, Suite C, Glendale, WI 53209-4218 | 2008-04-28 |
| 1366548919 | Olalekan Lukman Ganiyu | Clinic/Center | 2500 W Silver Spring Dr, Ste A, Glendale, WI 53209-4218 | 2006-09-14 |
| 1619932126 | Adedapo F Okusanya | Emergency Medicine | 2500 W Silver Spring Dr, Glendale, WI 53209-4218 | 2006-04-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780238253 | Niajcia Brookshire | Counselor | 3900 W Brown Deer Rd Suite 200, Brown Deer, WI 53209 | 2019-08-01 |
| 1740751015 | Mary Fuller | Home Health Aide | 3043 N 29th St., Milwaukee, WI 53209 | 2018-12-16 |
| 1154869410 | Jacksonscott2 | Skilled Nursing Facility | 4573 N. 22nd Street, Milwaukee, WI 53209 | 2017-02-07 |
| 1669910469 | Dimera House | In Home Supportive Care | 4002 W Fairount Ave, Milwaukee, WI 53209 | 2017-02-01 |
| 1891248340 | Amy L May | Nurse Practitioner | 3303 W Good Hope Rd, Milwaukee, WI 53209 | 2016-08-02 |
| 1871980193 | Alan R Rosenthal | Pharmacist | 6930 N Beech Tree Dr, Milwaukee, WI 53209 | 2015-04-24 |
| 1104212380 | Reema Shah | Student in an Organized Health Care Education/Training Program | 2400 W. Villard Ave, Milwaukee, WI 53209 | 2015-04-14 |
| 1336534403 | Robert Michael Kitsis | Family Medicine | 9252 N Green Bay Rd Fl 2, Brown Deer, WI 53209 | 2015-04-05 |
| 1962891994 | Kls Community Outreach Teen Center Consulting and Management L.L.C. | Public Health or Welfare | 8330 North Teutonia Ave Suite 103, Brown Deer, WI 53209 | 2015-01-14 |
| 1548659634 | Kls Community Outreach Teen Center Consulting and Management L.L.C. | Early Intervention Provider Agency | 8330 North Teutonia Avenue Suite 103, Brown Deer, WI 53209 | 2015-01-13 |
| Find all providers in zip 53209 | ||||
| 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 |
|---|---|---|---|---|
| 1578179859 | Y&g Pharmacy Inc | Pharmacy | 8017 Myrtle Ave, Glendale, NY 11385-7642 | 2020-09-22 |
| 1144845819 | Arka Rx Inc | Pharmacy | 621 E Glenoaks Blvd Ste C, Glendale, CA 91207-1775 | 2020-06-09 |
| 1356971006 | Myrtle Meds Inc | Pharmacy | 7617 Myrtle Ave, Glendale, NY 11385-7446 | 2020-01-22 |
| 1588201149 | Esmeralda Pharmacy Inc | Pharmacy | 6555 Myrtle Ave, Glendale, NY 11385-7028 | 2019-12-03 |
| 1093350993 | Accumed Inc | Pharmacy | 1851 Flower Street, Glendale, CA 91201 | 2019-11-14 |
| 1558929455 | Central Drugs Inc | Pharmacy | 6715 Central Ave, Glendale, NY 11385-6633 | 2019-06-05 |
| 1578033718 | Hayat Pharmacy 14 | Pharmacy | 2501 W Silver Spring Dr Ste 5, Glendale, WI 53209-4217 | 2018-11-30 |
| 1881184117 | Nairi Hayrapetian | Pharmacy | 2216 Sherwood Pl, Glendale, CA 91206-1138 | 2018-05-11 |
| 1316468432 | Cover Rx Inc | Pharmacy | 1811 W Glenoaks Blvd, Glendale, CA 91201-4376 | 2017-06-28 |
| 1649700832 | First Stop Pharmacy Inc | Pharmacy | 1577 E Chevy Chase Dr Ste 130, Glendale, CA 91206-4740 | 2017-06-19 |
| Find all providers in GLENDALE | ||||
Please comment or provide details below to improve the information on PROVIDENCE FAMILY PHARMACY LLC.
| 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.