Mide Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

MIDE INC.

Practice address

600 E Pioneer St Ste 3
Crandon, WI 54520-1662

Phone

(715) 478-3369

Fax

(715) 478-3945

NPI assigned

Jan 25, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Debra Moioffer

Title

President

Phone

(715) 781-3058

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Wolf River Pharmacy Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kayla Kircher, RN

  • Registered Nurse
  • Crandon, WI
  • NPI 1730995945
  NPD
• Michele Panske, RPH

  • Pharmacist
  • Marinette, WI
  • NPI 1194079236
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730764800000",
    "number": "1336295245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 E PIONEER ST STE 3",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "545201662",
            "telephone_number": "715-478-3369",
            "fax_number": "715-478-3945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 E PIONEER ST STE 3",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "545201662",
            "telephone_number": "715-478-3369",
            "fax_number": "715-478-3945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A",
        "authorized_official_last_name": "MOIOFFER",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-781-3058"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "7069042",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33134200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wolf River Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Linderud, PHARMD
• Dakota Ann Malzewski, DC
• Frederick A Mathwig, PT
• Lynette M McCorkle, LPC
• Laura L Meverden, APNP
• Karen A Minx, SAC
• Susan Elisabeth Moore, MD
• Frank Mraz, MD
• Newcap, Inc.
• Aubrey Leigh D Newton, LPC

• Community/Retail Pharmacy in Crandon, WI
• Providers in Crandon, WI by specialty
• Community/Retail Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.