Healthcare Provider Details

I. General information

NPI: 1700882008
Provider Name (Legal Business Name): DANAURA ENTERPRISES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2506 WILDWOOD ROAD
WILDWOOD PA
15091
US

IV. Provider business mailing address

PO BOX 238
WILDWOOD PA
15091-0238
US

V. Phone/Fax

Practice location:
  • Phone: 412-486-4588
  • Fax: 412-486-0246
Mailing address:
  • Phone: 412-486-4588
  • Fax: 412-486-0246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPP415155L
License Number StatePA

VIII. Authorized Official

Name: DR. DANIEL T WAGNER
Title or Position: PRESIDENT
Credential: PHARM. D., MBA, R.PH
Phone: 412-486-4588