Provider Demographics
NPI:1770138885
Name:WISEMAN, JOSHUA NEIL (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:NEIL
Last Name:WISEMAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 CHATTANOOGA RD
Mailing Address - Street 2:
Mailing Address - City:TUNNEL HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30755-9393
Mailing Address - Country:US
Mailing Address - Phone:706-673-5211
Mailing Address - Fax:
Practice Address - Street 1:3535 CHATTANOOGA RD
Practice Address - Street 2:
Practice Address - City:TUNNEL HILL
Practice Address - State:GA
Practice Address - Zip Code:30755-9393
Practice Address - Country:US
Practice Address - Phone:706-673-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist