Provider Demographics
NPI:1124535190
Name:WISE, TERESA I (PHARMD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:I
Last Name:WISE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S PONDS DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-1409
Mailing Address - Country:US
Mailing Address - Phone:713-442-4366
Mailing Address - Fax:
Practice Address - Street 1:1010 S PONDS DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-1409
Practice Address - Country:US
Practice Address - Phone:713-442-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist