Individual
AMANDA DIANE WISENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1700 E 38TH ST, MARION, IN 46953-4568
(765) 674-3321
(765) 677-5136
Mailing address
1700 E 38TH ST, MARION, IN 46953-4568
(765) 674-3321
(765) 677-5136
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
012226
KY
Other
Enumeration date
06/25/2020
Last updated
06/25/2020
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