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General NPI Number Information
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NPI Number | 1710911151
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Entity Type | Individual
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Provider Name | JOANNE MARY WISNIESKI RPH
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Gender | Female
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 400 FORT HILL AVE VAMC
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1159
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Country | US
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Telephone | 585-393-8043
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Fax |
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Provider Business Mailing Address
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Address Line | 20 LARCHMONT ST
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City | GENEVA
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State | NY
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Zip | 14456-1426
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Country | US
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Telephone | 315-789-2248
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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 | 30138
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License Number State | NY
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