Healthcare Provider Details

I. General information

NPI: 1952106072
Provider Name (Legal Business Name): DEXTER WIMER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

67 MOUNT VERNON AVE
SAN FRANCISCO CA
94112-3663
US

V. Phone/Fax

Practice location:
  • Phone: 540-280-1989
  • Fax:
Mailing address:
  • Phone: 540-280-1989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number77112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: