Healthcare Provider Details

I. General information

NPI: 1508211491
Provider Name (Legal Business Name): JOSHUA EDWIN WISER PHARMD, BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 10/19/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 FORT RICHARDSON AVE
GOODFELLOW AFB TX
76908
US

IV. Provider business mailing address

271 FT RICHARDSON AVE
GOODFELLOW AFB TX
76908
US

V. Phone/Fax

Practice location:
  • Phone: 325-654-5758
  • Fax:
Mailing address:
  • Phone: 325-654-5758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number1-16654
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number56478
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number56478
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number1-16654
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: