Healthcare Provider Details

I. General information

NPI: 1255440293
Provider Name (Legal Business Name): SWEET MEDICINE PRESCRIPTIONS PLUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N MAIN ST
IOLA WI
54945
US

IV. Provider business mailing address

155 N MAIN ST PO BOX 284
IOLA WI
54945
US

V. Phone/Fax

Practice location:
  • Phone: 715-445-3117
  • Fax: 715-445-4481
Mailing address:
  • Phone: 715-445-3117
  • Fax: 715-445-4481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7980-042
License Number StateWI

VIII. Authorized Official

Name: MS. SUSAN K SHAMBEAU
Title or Position: PHARMACIST OWNER
Credential: RPH
Phone: 715-455-3117