Provider Demographics
NPI:1558588236
Name:WISE PHARMACY
Entity Type:Organization
Organization Name:WISE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WISE
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:303-933-8181
Mailing Address - Street 1:6179 S BALSAM WAY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3091
Mailing Address - Country:US
Mailing Address - Phone:303-933-8181
Mailing Address - Fax:303-979-7915
Practice Address - Street 1:6179 S BALSAM WAY
Practice Address - Street 2:SUITE 150
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3091
Practice Address - Country:US
Practice Address - Phone:303-933-8181
Practice Address - Fax:303-979-7915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO79-31183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06-11942OtherNABP#
CO03079316Medicaid
CO02-65300001Medicare ID - Type Unspecified