Healthcare Provider Details

I. General information

NPI: 1215187455
Provider Name (Legal Business Name): WAGNER DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 HIGHWAY 270 E
MOUNT IDA AR
71957-8003
US

IV. Provider business mailing address

PO BOX 66
MOUNT IDA AR
71957-0066
US

V. Phone/Fax

Practice location:
  • Phone: 870-867-3174
  • Fax: 870-867-2033
Mailing address:
  • Phone: 870-867-3174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberAR15934
License Number StateAR

VIII. Authorized Official

Name: LAURA WAGNER
Title or Position: OWNER
Credential:
Phone: 870-867-2812