Healthcare Provider Details

I. General information

NPI: 1043222045
Provider Name (Legal Business Name): MARIA TREASE WISE R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 INDEPENDENCE AVE
AKRON OH
44310-1812
US

IV. Provider business mailing address

2291 MOHLER DR NW
NORTH CANTON OH
44720-5735
US

V. Phone/Fax

Practice location:
  • Phone: 330-633-8463
  • Fax: 330-630-4231
Mailing address:
  • Phone: 330-966-5714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03317223
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: