Individual
JASON WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
7930 NORTHFIELD BLVD, DENVER, CO 80238-3527
(303) 209-8721
Mailing address
3146 ELMIRA CT, DENVER, CO 80238-2929
(303) 981-8798
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
16028
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16028
CO STATE LICENSE NUMBER
CO
Enumeration date
06/13/2011
Last updated
06/13/2011
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