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General NPI Number Information
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NPI Number | 1932704244
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Entity Type | Individual
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Provider Name | CYNTHIA B WIESE RPH
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Gender | Female
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Dates
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Enumeration Date | 12/03/2020
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 4 WHITE HORSE PIKE
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City | OAKLYN
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State | NJ
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Zip | 08107-1468
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Country | US
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Telephone | 856-869-3060
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Fax |
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Provider Business Mailing Address
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Address Line | 3 ACORN HILL HOLW
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City | VOORHEES
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State | NJ
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Zip | 08043-1524
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Country | US
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Telephone | 609-313-0234
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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 | 28RI01687800
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License Number State | NJ
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