Provider Demographics
NPI:1710292644
Name:WISE, STEPHEN LEWIS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEWIS
Last Name:WISE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5410 MARYLAND WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5064
Mailing Address - Country:US
Mailing Address - Phone:615-942-2639
Mailing Address - Fax:877-425-0799
Practice Address - Street 1:2717 MURFREESBORO PIKE
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2003
Practice Address - Country:US
Practice Address - Phone:615-600-5116
Practice Address - Fax:629-202-8956
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN43110183500000X
IA21086183500000X
TX49145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist