Provider Demographics
NPI:1124391024
Name:WISE, LINDSAY (RPH, PHARM D)
Entity Type:Individual
Prefix:MS
First Name:LINDSAY
Middle Name:
Last Name:WISE
Suffix:
Gender:F
Credentials:RPH, PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 SANTIAM HWY SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-5265
Mailing Address - Country:US
Mailing Address - Phone:541-967-6730
Mailing Address - Fax:
Practice Address - Street 1:2500 SANTIAM HWY SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-5265
Practice Address - Country:US
Practice Address - Phone:541-967-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0011369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist