Healthcare Provider Details

I. General information

NPI: 1417617838
Provider Name (Legal Business Name): JACOB MICHAEL WISEMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 STEFFEN AVE
CINCINNATI OH
45215-2338
US

IV. Provider business mailing address

5260 PLEASANT CHAPEL RD
SOUTH VIENNA OH
45369-9763
US

V. Phone/Fax

Practice location:
  • Phone: 513-554-4100
  • Fax:
Mailing address:
  • Phone: 937-926-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03441173
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: