Individual
TYLER WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
515 S 500 W, BOUNTIFUL, UT 84010
(801) 294-9107
Mailing address
21 ACORN DRIVE, NORTH SALT LAKE, UT 84054
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
4768002-1701
UT
Other
Enumeration date
11/19/2011
Last updated
11/19/2011
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