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General NPI Number Information
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NPI Number | 1497969414
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Entity Type | Organization
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Legal Business Name | WAGNER DRUG CORPORATION
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1106 ORANGE AVE
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City | CORONADO
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State | CA
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Zip | 92118-3407
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Country | US
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Telephone | 619-435-4171
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Fax | 619-435-1926
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Provider Business Mailing Address
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Address Line | 1106 ORANGE AVE
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City | CORONADO
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State | CA
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Zip | 92118-3407
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Country | US
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Telephone | 619-435-4171
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Fax | 619-435-1926
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHARLES LANIER WAGNER
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Credential | RPH
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Telephone | 619-435-4171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 24978
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License Number State | CA
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