Provider Demographics
NPI:1184719361
Name:WISE'S DRUGSTORE
Entity type:Organization
Organization Name:WISE'S DRUGSTORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:H
Authorized Official - Last Name:WISE
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:352-372-4371
Mailing Address - Street 1:239 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-5211
Mailing Address - Country:US
Mailing Address - Phone:352-372-4371
Mailing Address - Fax:352-377-6268
Practice Address - Street 1:239 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-5211
Practice Address - Country:US
Practice Address - Phone:352-372-4371
Practice Address - Fax:352-377-6268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH3733336C0003X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0836610002Medicare ID - Type Unspecified