Healthcare Provider Details

I. General information

NPI: 1235048646
Provider Name (Legal Business Name): HARVEY WILLIAM WAGLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BILL WAGLEY BSPHARM, PHARMD, RPH

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5704 SAWYERS GREEN TRL
SEYMOUR TN
37865-3221
US

IV. Provider business mailing address

5704 SAWYERS GREEN TRL
SEYMOUR TN
37865-3221
US

V. Phone/Fax

Practice location:
  • Phone: 630-815-4807
  • Fax:
Mailing address:
  • Phone: 630-815-4807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051039217
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17376
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: