Saint-Mark Enterprises 1855 LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SAINT-MARK ENTERPRISES 1855 LLC

Doing business as

Medicine Shoppe

Practice address

110 E Oak St
Frederic, WI 54837

Phone

(715) 327-4208

NPI assigned

Jan 8, 2009

Last updated

Jul 22, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark Miller

Title

Owner

Phone

(314) 518-2427

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• MEDICINE SHOPPE Doing business as

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

{
    "created_epoch": "1231372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248220800000",
    "number": "1447497763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 98",
            "city": "EUREKA",
            "state": "MO",
            "postal_code": "630250098",
            "telephone_number": "314-518-2427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E OAK ST",
            "city": "FREDERIC",
            "state": "WI",
            "postal_code": "54837",
            "telephone_number": "715-327-4208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT-MARK ENTERPRISES 1855 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-08",
        "last_updated": "2009-07-22",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-518-2427"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP #",
            "identifier": "5131331",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002192",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICINE SHOPPE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kandis Joy Olson, OTR
• Orion Frederic LLC (Frederic Nursing and Rehabilitation Community)
• Pharmacy Operations Inc (Medicine Shoppe)
• Robin V Richey, RN
• Debra Marie Roehm, PHARMD
• Jennifer Lee Schill, MFT
• Joshua Joel Schoessow, APSW
• School District of Frederic
• St Croix Falls Eye Associates Inc. (Frederic Eye Associates)
• St. Croix Regional Medical Center

• Community/Retail Pharmacy in Frederic, WI
• Providers in Frederic, 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 Jul 22, 2009; 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.