Provider Demographics
NPI:1487296737
Name:XPERIENCE PHARMACY LLC
Entity type:Organization
Organization Name:XPERIENCE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:SADE
Authorized Official - Last Name:ISIEKWENE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:773-432-5594
Mailing Address - Street 1:5715 W APPLETON AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2250
Mailing Address - Country:US
Mailing Address - Phone:414-988-2188
Mailing Address - Fax:414-988-2187
Practice Address - Street 1:5715 W APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2250
Practice Address - Country:US
Practice Address - Phone:414-988-2188
Practice Address - Fax:414-988-2187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy