Healthcare Provider Details

I. General information

NPI: 1700284379
Provider Name (Legal Business Name): JOSHUA WISE PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMONWEALTH HEALTH CENTER 2ND FLOOR PHI PHARMACY
SAIPAN MP
96950
US

IV. Provider business mailing address

PO BOX 506338
SAIPAN MP
96950-4334
US

V. Phone/Fax

Practice location:
  • Phone: 670-323-5000
  • Fax:
Mailing address:
  • Phone: 670-323-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0089
License Number StateMP
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH-3696
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: