Provider Demographics
NPI:1508336207
Name:WISE, AUSTIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:WISE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 SENNA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-0512
Mailing Address - Country:US
Mailing Address - Phone:704-814-0154
Mailing Address - Fax:704-814-0520
Practice Address - Street 1:2925 SENNA DR STE 100
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-0512
Practice Address - Country:US
Practice Address - Phone:704-814-0154
Practice Address - Fax:704-814-0520
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist