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General NPI Number Information
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NPI Number | 1710292644
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Entity Type | Individual
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Provider Name | STEPHEN LEWIS WISE PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 2717 MURFREESBORO PIKE
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City | ANTIOCH
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State | TN
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Zip | 37013-2003
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Country | US
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Telephone | 615-600-5116
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Fax | 629-202-8956
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Provider Business Mailing Address
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Address Line | 5410 MARYLAND WAY
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City | BRENTWOOD
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State | TN
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Zip | 37027-5064
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Country | US
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Telephone | 615-942-2639
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Fax | 877-425-0799
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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 | 43110
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 21086
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 49145
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License Number State | TX
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