Healthcare Provider Details

I. General information

NPI: 1851208698
Provider Name (Legal Business Name): ALYNNE BERI WAGNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 HANOVER PIKE
HAMPSTEAD MD
21074-1150
US

IV. Provider business mailing address

1053 FREELAND RD
FREELAND MD
21053-9690
US

V. Phone/Fax

Practice location:
  • Phone: 410-239-3750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number31123
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: