MEDICARE: JEANNE SACKMANN

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	183500000X	Pharmacist	11782	WI

General Provider Information

NPI Number	:	1558971671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE SACKMANN

Provider Business Mailing Address
First Line	:	1324 W CLAIREMONT AVE STE 3
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54701-6191
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	153 W LINCOLN ST
Second Line	:
City	:	AUGUSTA
State	:	WI
Zip	:	54722-9152
Country	:	US
Telephone Number	:	715-286-2515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2020
Last Update Date	:	08/04/2020

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Directions to “ JEANNE SACKMANN ” Practice Location

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