Provider Demographics
NPI:1093476392
Name:WISEGROUP LLC
Entity Type:Organization
Organization Name:WISEGROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:RHEA
Authorized Official - Last Name:SHOWN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:270-885-6131
Mailing Address - Street 1:3217 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-3815
Mailing Address - Country:US
Mailing Address - Phone:270-885-6131
Mailing Address - Fax:270-885-6132
Practice Address - Street 1:3217 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-3815
Practice Address - Country:US
Practice Address - Phone:270-885-6131
Practice Address - Fax:270-885-6132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy