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NPI Code Detail

MEDICARE: RACHAEL EILEEN WISDOM PHARMD

MEDICARE: RACHAEL EILEEN WISDOM 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
1183500000XPharmacist42361TN

General Provider Information

NPI Number : 1659991024
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHAEL EILEEN WISDOM PHARMD
Provider Business Mailing Address
First Line : 15 FIELDDALE DR
Second Line :
City : JACKSON
State : TN
Zip : 38305-9517
Country : US
Telephone Number : 931-628-6102
Fax Number :
Provider Business Practice Location Address
First Line : 2615 LAKE RD
Second Line :
City : DYERSBURG
State : TN
Zip : 38024-1605
Country : US
Telephone Number : 731-288-5065
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2020
Last Update Date : 04/25/2020

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