Healthcare Provider Details

I. General information

NPI: 1780667352
Provider Name (Legal Business Name): MS. JODIANNE BUXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. JODIANNE WAGNER

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 E ROWAN AVE
SPOKANE WA
99207-1232
US

IV. Provider business mailing address

3625 E NORWOOD RD
COLBERT WA
99005-9764
US

V. Phone/Fax

Practice location:
  • Phone: 509-482-3057
  • Fax:
Mailing address:
  • Phone: 509-723-5498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPH00059951
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: