Healthcare Provider Details

I. General information

NPI: 1356543664
Provider Name (Legal Business Name): STEPHEN SCOTT WISNESKI PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E MARKET ST
AKRON OH
44304-1619
US

IV. Provider business mailing address

10871 THORESBY CIR NW
UNIONTOWN OH
44685-6855
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-3164
  • Fax:
Mailing address:
  • Phone: 330-375-3164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03322172
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: