Organization · Type 2 NPI

Providence Family Pharmacy LLC

Community/Retail Pharmacy · Glendale, WI

NPI number 1386190247 Active

Practice location

2500 W Silver Spring Dr
Glendale, WI 53209-4218

Fax (414) 885-0552

Specialties and licenses

Taxonomy	Code	License
Pharmacy	333600000X	None listed
Community/Retail Pharmacy Primary	3336C0003X	9428-42 (WI)
Long Term Care Pharmacy	3336L0003X	None listed

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 …

7 other providers at this address

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NPI record

NPI: 1386190247
Entity type: Organization (Type 2)
Issued: Aug 31, 2016
Last updated: Feb 20, 2020
Status: Active

Other names

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Providence Family Pharmacy LLC · doing business as
Providence Family Pharmacy LLC · doing business as

Authorized official

Abiola Okusanya
Manager
(414) 885-0550

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1386190247

Providence Family Pharmacy LLC's National Provider Identifier is 1386190247, issued on Aug 31, 2016. The primary taxonomy on file is Community/Retail Pharmacy (3336C0003X), and the practice location is in Glendale, WI. The record was last updated on Feb 20, 2020.