Provider Demographics
NPI:1477339299
Name:WISDOM PHARMACY LLC
Entity Type:Organization
Organization Name:WISDOM PHARMACY LLC
Other - Org Name:WISDOM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FOUAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SORIAL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-419-0808
Mailing Address - Street 1:311 MEDICAL CT
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2817
Mailing Address - Country:US
Mailing Address - Phone:304-378-2233
Mailing Address - Fax:304-378-2230
Practice Address - Street 1:311 MEDICAL CT
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2817
Practice Address - Country:US
Practice Address - Phone:304-419-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty