Provider Demographics
NPI:1891708434
Name:ALLIANCE PHARMACY SERVICES
Entity type:Organization
Organization Name:ALLIANCE PHARMACY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:WASSENAAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-986-2560
Mailing Address - Street 1:9301 N 76TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-1003
Mailing Address - Country:US
Mailing Address - Phone:414-357-5104
Mailing Address - Fax:414-357-5156
Practice Address - Street 1:9301 N 76TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-1003
Practice Address - Country:US
Practice Address - Phone:414-357-5104
Practice Address - Fax:414-357-5156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI82100473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33261600Medicaid
WI33261600Medicaid