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General NPI Number Information
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NPI Number | 1386249266
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Entity Type | Individual
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Provider Name | MICHAEL CRAIG WISOTSKY PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 246 NORWOOD AVE
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City | OAKHURST
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State | NJ
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Zip | 07755-1747
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Country | US
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Telephone | 732-502-3154
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Fax |
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Provider Business Mailing Address
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Address Line | 1232 LUKAS BLVD
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City | MORGANVILLE
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State | NJ
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Zip | 07751-9754
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Country | US
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Telephone |
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 28RI03432600
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License Number State | NJ
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