Provider Demographics
NPI:1659040772
Name:WISHNIA, FRANK
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:WISHNIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 BUNKER HILL DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2771
Mailing Address - Country:US
Mailing Address - Phone:502-939-0063
Mailing Address - Fax:
Practice Address - Street 1:3997 7TH STREET RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4103
Practice Address - Country:US
Practice Address - Phone:502-448-3383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-11
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist