Provider Demographics
NPI:1366583817
Name:WISE'S PARKWOOD
Entity type:Organization
Organization Name:WISE'S PARKWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTPHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:352-373-3547
Mailing Address - Street 1:3842 NEWBERRY RD STE 1G
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-4833
Mailing Address - Country:US
Mailing Address - Phone:352-373-3547
Mailing Address - Fax:352-373-1532
Practice Address - Street 1:3842 NEWBERRY RD STE 1G
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-4833
Practice Address - Country:US
Practice Address - Phone:352-373-3547
Practice Address - Fax:352-373-1532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102198201Medicaid
FL102198200Medicaid