MEDICARE: HEALTHWISE PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PH13181	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2013524	OTHER		PK

General Provider Information

NPI Number	:	1104920156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHWISE PHARMACY

Provider Business Mailing Address
First Line	:	2708 W WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1837
Country	:	US
Telephone Number	:	813-932-6337
Fax Number	:	813-932-7455

Provider Business Practice Location Address
First Line	:	2708 W WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1837
Country	:	US
Telephone Number	:	813-932-6337
Fax Number	:	813-932-7455

Authorized Official
Title or Position	:	OWNER/PIC/AO
Name	:	VIRAL SHAH
Credential	:	RPH
Telephone Number	:	813-932-6337

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	07/19/2018

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Directions to “HEALTHWISE PHARMACY ” Practice Location

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