Healthcare Provider Details

I. General information

NPI: 1235045923
Provider Name (Legal Business Name): SYDNEY LIEDING WEISE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

7439 HARWOOD AVE STE 103
WAUWATOSA WI
53213-2665
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-6000
  • Fax:
Mailing address:
  • Phone: 262-388-5932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23438-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: