Most Relevant Information
Provider Data
| NPI Number: | 1003547951 |
| Provider Name: | BRENDA WISE |
| Entity Type: | Individual |
| Taxonomy Code: | 183700000X |
| Specialty: | Pharmacy Technician |
| License Number: | TCH31540 |
Most Important Dates
| Enumeration Date: | 06/22/2022 |
| Last Updated: | 06/22/2022 |
Provider Practice Location
1380 BARSTOW RD
BARSTOW
CA
923114944
Practice Location Phone/Fax
| Phone: | 7602523502 |
| Fax: |
Provider Mailing Location
1380 BARSTOW RD
BARSTOW
CA
923114944
Provider Mailing Phone/Fax
| Phone: | 7602523502 |
| Fax: |