Provider Demographics
NPI:1992815682
Name:DEAN RETAIL SERVICES, INC.
Entity type:Organization
Organization Name:DEAN RETAIL SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:GRINNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-260-3586
Mailing Address - Street 1:P.O BOX 259443
Mailing Address - Street 2:ATTN: SSM HEALTH PHARMACY ADMIN
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53725-9443
Mailing Address - Country:US
Mailing Address - Phone:608-250-1450
Mailing Address - Fax:608-824-2690
Practice Address - Street 1:3200 EAST RACINE STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-2343
Practice Address - Country:US
Practice Address - Phone:608-371-8100
Practice Address - Fax:608-371-8105
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEAN HEALTH SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33205500Medicaid
WI33205500Medicaid
WI0419360016Medicare NSC