MEDICARE: DR. STEPHEN LEWIS WISE PHARM.D

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	43110	TN
2	183500000X	Pharmacist	21086	IA
3	183500000X	Pharmacist	49145	TX

General Provider Information

NPI Number	:	1710292644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN LEWIS WISE PHARM.D

Provider Business Mailing Address
First Line	:	5410 MARYLAND WAY
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-5064
Country	:	US
Telephone Number	:	615-942-2639
Fax Number	:	877-425-0799

Provider Business Practice Location Address
First Line	:	2717 MURFREESBORO PIKE
Second Line	:
City	:	ANTIOCH
State	:	TN
Zip	:	37013-2003
Country	:	US
Telephone Number	:	615-600-5116
Fax Number	:	629-202-8956

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

Provider Enumeration Date	:	08/16/2010
Last Update Date	:	01/19/2022

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