Individual
KAYLA RUTH WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2130 MARCOLA RD, SPRINGFIELD, OR 97477-2592
(541) 747-3362
(541) 741-2287
Mailing address
2914 CHANDLER AVE, EUGENE, OR 97403-2232
(541) 255-7763
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
CPT-0012209
OR
Other
Enumeration date
07/11/2021
Last updated
07/11/2021
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