MEDICARE: ANTHONY M WISEMAN PHARM.D.

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	183500000X	Pharmacist	S015592	AZ
2	183500000X	Pharmacist	RP441048	PA

General Provider Information

NPI Number	:	1649585795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY M WISEMAN PHARM.D.

Provider Business Mailing Address
First Line	:	4121 E COTTON CENTER BLVD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-8849
Country	:	US
Telephone Number	:	602-431-5149
Fax Number	:

Provider Business Practice Location Address
First Line	:	4121 E COTTON CENTER BLVD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-8849
Country	:	US
Telephone Number	:	602-431-5149
Fax Number	:

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

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	06/14/2016

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