Provider Demographics
NPI:1164853768
Name:WISNIEWSKI, SARAH L (PHARMD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 CENTURY CENTER ST SW
Mailing Address - Street 2:PHARMACY
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-3101
Mailing Address - Country:US
Mailing Address - Phone:616-724-2810
Mailing Address - Fax:
Practice Address - Street 1:3434 CENTURY CENTER DR
Practice Address - Street 2:PHARMACY
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418
Practice Address - Country:US
Practice Address - Phone:616-724-2810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist