Healthcare Provider Details

I. General information

NPI: 1114693702
Provider Name (Legal Business Name): NICHELLE SCHLOEMER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 BELKNAP ST
SUPERIOR WI
54880-2900
US

IV. Provider business mailing address

204 BELKNAP ST
SUPERIOR WI
54880-2900
US

V. Phone/Fax

Practice location:
  • Phone: 715-817-7146
  • Fax:
Mailing address:
  • Phone: 715-817-7146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number122756
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number18532
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: