Individual
TODD ROBERT WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM D
Contact information
Practice address
5353 W 11000 N, HIGHLAND, UT 84003-9403
(801) 756-8353
Mailing address
621 WASHINGTON ST S, TWIN FALLS, ID 83301-5519
(801) 358-3365
(208) 567-5622
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
6596013-1701
UT
Other
Enumeration date
07/31/2017
Last updated
07/31/2017
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