Individual
IVAN WESLEY WISCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1170 EMMET ST N, CHARLOTTESVILLE, VA 22903-4836
(434) 293-9151
Mailing address
1170 EMMET ST N, CHARLOTTESVILLE, VA 22903-4836
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202220011
VA
Other
Enumeration date
05/02/2022
Last updated
05/02/2022
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