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General NPI Number Information
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NPI Number | 1780863175
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Entity Type | Organization
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Legal Business Name | BI-WISE PHARMACY & COMPOUNDING
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 3165 N MCMULLEN BOOTH RD BLDG F SUITE 1
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City | CLEARWATER
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State | FL
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Zip | 33761-2032
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Country | US
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Telephone | 727-724-3112
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Fax | 727-724-3112
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Provider Business Mailing Address
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Address Line | 3165 N MCMULLEN BOOTH RD BLDG F SUITE 1
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City | CLEARWATER
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State | FL
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Zip | 33761-2032
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Country | US
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Telephone | 727-724-3112
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Fax | 727-724-3112
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MRS. KATIE CORBIN
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Credential | B.S
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Telephone | 727-724-3112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | PS 24880
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License Number State | FL
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