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MR. GARY MARK WISE RPH

>> Pharmacist >> Pharmacy Service Providers

Registrant NPI Number: 1891990131

Individual Registrant:
MR. GARY MARK WISE RPH
Gender: M
Sole Proprietor

Location and contact information for practice:
470 SAFFORD AVE W  THOMASVILLE, AL 36784-3112 US
Tel: 334-636-9809  Fax: 334-636-9807

Contact information for business:
470 SAFFORD AVE W  THOMASVILLE, AL 36784-3112 US
Tel: 334-636-9809  Fax: 334-636-9807

Registration Information:
NPI: 1891990131
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y183500000XPharmacy Service Providers
Pharmacist
AL9084

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
NABP NUMBER0118794AL01




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