Active NPI
Jesse Ryan Wisniewski, PHARM.D.
- Pharmacotherapy Pharmacist
- West Hollywood, CA
National Provider Identifier
1023461704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacotherapy Pharmacist
- License
- 67195
- Practice address
- 8700 Beverly Blvd
Room A903
West Hollywood, CA 90048-1804 - Phone
- (310) 423-5611
- Fax
- (310) 423-0412
- NPI assigned
- Jul 19, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | 67195 | CA | Primary |
Addresses
Primary practice location
8700 Beverly Blvd
Room A903
West Hollywood, CA 90048-1804
Mailing address
8700 Beverly Blvd
Room A903
West Hollywood, CA 90048-1804
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 67195 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468886400000",
"number": "1023461704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8700 BEVERLY BLVD",
"address_2": "ROOM A903",
"city": "WEST HOLLYWOOD",
"state": "CA",
"postal_code": "900481804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8700 BEVERLY BLVD",
"address_2": "ROOM A903",
"city": "WEST HOLLYWOOD",
"state": "CA",
"postal_code": "900481804",
"telephone_number": "310-423-5611",
"fax_number": "310-423-0412"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISNIEWSKI",
"first_name": "JESSE",
"middle_name": "RYAN",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-07-19",
"last_updated": "2016-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "CA",
"license": "67195",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Hollywood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.