MEDICARE: ERIC WIGMOSTA PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH60557087	WA

General Provider Information

NPI Number	:	1003284522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC WIGMOSTA PHARMD

Provider Business Mailing Address
First Line	:	5506 N ROAD 68
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99301-9627
Country	:	US
Telephone Number	:	509-547-1789
Fax Number	:

Provider Business Practice Location Address
First Line	:	5506 N ROAD 68
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99301-9627
Country	:	US
Telephone Number	:	509-547-1789
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2015
Last Update Date	:	09/14/2015

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Directions to “ ERIC WIGMOSTA PHARMD” Practice Location

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