Provider Demographics
NPI:1639574932
Name:CPI MENOMONIE LLC
Entity Type:Organization
Organization Name:CPI MENOMONIE LLC
Other - Org Name:THE MEDICINE SHOPPE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER - PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-861-4422
Mailing Address - Street 1:13 E SPRUCE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-2579
Mailing Address - Country:US
Mailing Address - Phone:715-861-4422
Mailing Address - Fax:715-861-7150
Practice Address - Street 1:1302 STOUT RD
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2979
Practice Address - Country:US
Practice Address - Phone:715-309-4329
Practice Address - Fax:715-309-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WI9288-423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148740OtherPK
WI100043217Medicaid
WI7544660001Medicare NSC