Provider Demographics
NPI:1255440293
Name:SWEET MEDICINE PRESCRIPTIONS PLUS INC
Entity type:Organization
Organization Name:SWEET MEDICINE PRESCRIPTIONS PLUS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHAMBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:715-455-3117
Mailing Address - Street 1:155 N MAIN ST
Mailing Address - Street 2:PO BOX 284
Mailing Address - City:IOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54945
Mailing Address - Country:US
Mailing Address - Phone:715-445-3117
Mailing Address - Fax:715-445-4481
Practice Address - Street 1:155 N MAIN ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:WI
Practice Address - Zip Code:54945
Practice Address - Country:US
Practice Address - Phone:715-445-3117
Practice Address - Fax:715-445-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7980-042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33214300Medicaid
WI33214300Medicaid