Provider Demographics
NPI:1073563607
Name:XME INC
Entity Type:Organization
Organization Name:XME INC
Other - Org Name:MIDLAND SABOURIN'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WYSOPAL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:989-839-2403
Mailing Address - Street 1:314 W WACKERLY ST STE L
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2766
Mailing Address - Country:US
Mailing Address - Phone:989-839-2402
Mailing Address - Fax:989-839-2405
Practice Address - Street 1:314 W WACKERLY ST STE L
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2766
Practice Address - Country:US
Practice Address - Phone:989-839-2402
Practice Address - Fax:989-839-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010075013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2046023OtherPK
MI1073563607Medicaid
MI483336Medicaid