Provider Demographics
NPI:1619171816
Name:WIZWER, PHILLIP I (RPH)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:I
Last Name:WIZWER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CLARISSA RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-4739
Mailing Address - Country:US
Mailing Address - Phone:978-256-7886
Mailing Address - Fax:617-732-2244
Practice Address - Street 1:179 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5896
Practice Address - Country:US
Practice Address - Phone:617-732-2972
Practice Address - Fax:617-732-2244
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist