Healthcare Provider Details

I. General information

NPI: 1962491399
Provider Name (Legal Business Name): STEVEN WAGERS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 LEGACY DR
BEREA KY
40403-9594
US

IV. Provider business mailing address

1820 MALLARD DR
LONDON KY
40741-9748
US

V. Phone/Fax

Practice location:
  • Phone: 859-986-2323
  • Fax:
Mailing address:
  • Phone: 606-877-3190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number012026
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: