Active NPI
Shawn Marie Wiacek, PHARMD
- Pharmacist
- Walled Lake, MI
National Provider Identifier
1871962597
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302040781
- Practice address
- 1129 Sigma Rd
Walled Lake, MI 48390-3754 - Phone
- (248) 660-4251
- NPI assigned
- Sep 23, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302040781 | MI | Primary |
Addresses
Primary practice location
1129 Sigma Rd
Walled Lake, MI 48390-3754
Mailing address
1129 Sigma Rd
Walled Lake, MI 48390-3754
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302040781 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447632000000",
"number": "1871962597",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1129 SIGMA RD",
"city": "WALLED LAKE",
"state": "MI",
"postal_code": "483903754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1129 SIGMA RD",
"city": "WALLED LAKE",
"state": "MI",
"postal_code": "483903754",
"telephone_number": "248-660-4251"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIACEK",
"first_name": "SHAWN",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-09-23",
"last_updated": "2015-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302040781",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Walled Lake, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.