Provider Demographics
NPI:1780863175
Name:BI-WISE PHARMACY & COMPOUNDING
Entity Type:Organization
Organization Name:BI-WISE PHARMACY & COMPOUNDING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:727-724-3112
Mailing Address - Street 1:3165 N MCMULLEN BOOTH RD BLDG F
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2032
Mailing Address - Country:US
Mailing Address - Phone:727-724-3112
Mailing Address - Fax:727-724-3112
Practice Address - Street 1:3165 N MCMULLEN BOOTH RD BLDG F
Practice Address - Street 2:SUITE 1
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2032
Practice Address - Country:US
Practice Address - Phone:727-724-3112
Practice Address - Fax:727-724-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 248803336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy