Healthcare Provider Details

I. General information

NPI: 1619883469
Provider Name (Legal Business Name): EMMANUEL WHEAGAR II PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 132ND AVE NE
BLAINE MN
55449-5377
US

IV. Provider business mailing address

2412 132ND AVE NE
BLAINE MN
55449-5377
US

V. Phone/Fax

Practice location:
  • Phone: 952-256-1624
  • Fax:
Mailing address:
  • Phone: 952-256-1624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number127160
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: