Healthcare Provider Details

I. General information

NPI: 1366583817
Provider Name (Legal Business Name): WISE'S PARKWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 11/19/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3842 NEWBERRY RD STE 1G
GAINESVILLE FL
32607-4833
US

IV. Provider business mailing address

3842 NEWBERRY RD STE 1G
GAINESVILLE FL
32607-4833
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-3547
  • Fax: 352-373-1532
Mailing address:
  • Phone: 352-373-3547
  • Fax: 352-373-1532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. PHIL GAGE
Title or Position: PRESIDENTPHARMACIST
Credential: RPH
Phone: 352-373-3547