Provider Demographics
NPI:1356626493
Name:WIEMANN, SEAN K (PHARM D)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:K
Last Name:WIEMANN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 BROADWAY DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-1090
Mailing Address - Country:US
Mailing Address - Phone:608-576-1049
Mailing Address - Fax:
Practice Address - Street 1:607 PARK AVE
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-2201
Practice Address - Country:US
Practice Address - Phone:920-356-0148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15522-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist