Healthcare Provider Details

I. General information

NPI: 1982988770
Provider Name (Legal Business Name): CHRISTOPHER EDWARD WAGMAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30550 STEPHENSON HWY
MADISON HEIGHTS MI
48071-1611
US

IV. Provider business mailing address

30550 STEPHENSON HWY
MADISON HEIGHTS MI
48071-1611
US

V. Phone/Fax

Practice location:
  • Phone: 248-616-0064
  • Fax: 248-616-0214
Mailing address:
  • Phone: 248-616-0064
  • Fax: 248-616-0214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302411179
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: