MEDICARE: JOHN WISHER

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	2667	MT

General Provider Information

NPI Number	:	1184055725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN WISHER

Provider Business Mailing Address
First Line	:	195 3RD AVENUE
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901
Country	:	US
Telephone Number	:	406-257-1397
Fax Number	:

Provider Business Practice Location Address
First Line	:	195 3RD AVENUE
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-4109
Country	:	US
Telephone Number	:	406-257-1397
Fax Number	:

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

Provider Enumeration Date	:	12/09/2013
Last Update Date	:	12/09/2013

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