Healthcare Provider Details

I. General information

NPI: 1740957471
Provider Name (Legal Business Name): JESSICA ELISE WISNIEWSKI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N EL CIELO RD STE C326
PALM SPRINGS CA
92262-6992
US

IV. Provider business mailing address

449 E ARENAS RD APT 302
PALM SPRINGS CA
92262-6655
US

V. Phone/Fax

Practice location:
  • Phone: 760-969-6560
  • Fax:
Mailing address:
  • Phone: 951-837-1739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number84804
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: