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General NPI Number Information
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NPI Number | 1760459804
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Entity Type | Individual
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Provider Name | MICHAEL M WYMAN PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 4445 S EASTERN AVE STE 2
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City | LAS VEGAS
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State | NV
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Zip | 89119-7851
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Country | US
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Telephone | 702-745-3500
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Fax | 702-745-4093
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Provider Business Mailing Address
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Address Line | 5829 PIRATE SHIP DR
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-3496
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Country | US
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Telephone | 928-550-0865
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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 | 10813
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 20109
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License Number State | NV
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