MEDICARE: PATRICIA WIGLE PHARMD

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	1835P1200X	Pharmacotherapy Pharmacist	03-3-24315	OH

General Provider Information

NPI Number	:	1508064361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA WIGLE PHARMD

Provider Business Mailing Address
First Line	:	3225 EDEN AVE
Second Line	:	304 WHERRY HALL
City	:	CINCINNATI
State	:	OH
Zip	:	45267-0001
Country	:	US
Telephone Number	:	513-558-4670
Fax Number	:	513-558-0731

Provider Business Practice Location Address
First Line	:	3225 EDEN AVE
Second Line	:	304 WHERRY HALL
City	:	CINCINNATI
State	:	OH
Zip	:	45267-0001
Country	:	US
Telephone Number	:	513-558-4670
Fax Number	:	513-558-0731

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	07/08/2007

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