MEDICARE: JOE M WEDIG 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	03230550	OH
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	015102	KY

General Provider Information

NPI Number	:	1801115431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOE M WEDIG PHARM.D.

Provider Business Mailing Address
First Line	:	503 HAPPY DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-5221
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5080 DELHI PIKE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-5343
Country	:	US
Telephone Number	:	513-451-7050
Fax Number	:	513-451-0172

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

Provider Enumeration Date	:	05/21/2010
Last Update Date	:	06/03/2011

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