Provider Demographics
NPI:1033430301
Name:MEDWISE INC
Entity Type:Organization
Organization Name:MEDWISE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASADEVALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-360-5955
Mailing Address - Street 1:4451 NW 36TH ST
Mailing Address - Street 2:# 110
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7285
Mailing Address - Country:US
Mailing Address - Phone:786-360-5955
Mailing Address - Fax:786-360-5993
Practice Address - Street 1:4451 NW 36TH ST
Practice Address - Street 2:# 110
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-7285
Practice Address - Country:US
Practice Address - Phone:786-360-5955
Practice Address - Fax:786-360-5993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy