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General NPI Number Information
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NPI Number | 1174090799
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Entity Type | Organization
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Legal Business Name | WISEGROUP LLC
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Dates
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Enumeration Date | 11/01/2018
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 289 MAIN ST
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City | CADIZ
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State | KY
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Zip | 42211-9151
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Country | US
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Telephone | 270-882-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 289 MAIN ST
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City | CADIZ
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State | KY
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Zip | 42211-9151
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Country | US
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Telephone | 270-882-2222
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Fax | 270-882-6337
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. JAMES B WISEMAN
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Credential | PHAMD.
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Telephone | 270-882-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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