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General NPI Number Information
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NPI Number | 1013091412
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Entity Type | Individual
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Provider Name | STEPHEN WILLIAM WISEMAN PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2215 FULLER RD
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City | ANN ARBOR
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State | MI
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Zip | 48105-2335
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Country | US
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Telephone | 734-769-7100
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Fax | 734-761-5590
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Provider Business Mailing Address
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Address Line | 2919 BURLINGTON CT
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City | ANN ARBOR
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State | MI
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Zip | 48105-1479
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Country | US
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Telephone | 734-663-3217
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 36784
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 5302025614
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License Number State | MI
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