Individual
DIANE L WISE TRIAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12100 N THORNYDALE RD, MARANA, AZ 85658-4755
(520) 572-6041
Mailing address
12100 N THORNYDALE RD, MARANA, AZ 85658-4755
(520) 572-6041
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S008949
AZ
Other
Enumeration date
09/10/2010
Last updated
09/10/2010
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