MEDICARE: XPERIENCE PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1487296737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	XPERIENCE PHARMACY LLC

Provider Business Mailing Address
First Line	:	5715 W APPLETON AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-2250
Country	:	US
Telephone Number	:	414-988-2188
Fax Number	:	414-988-2187

Provider Business Practice Location Address
First Line	:	5715 W APPLETON AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-2250
Country	:	US
Telephone Number	:	414-988-2188
Fax Number	:	414-988-2187

Authorized Official
Title or Position	:	MANAGING PHARMACIST
Name	:	DEBBIE SADE ISIEKWENE
Credential	:	PHARMD
Telephone Number	:	773-432-5594

Provider Enumeration Date	:	10/08/2019
Last Update Date	:	05/02/2025

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