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General NPI Number Information
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NPI Number | 1568477198
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Entity Type | Organization
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Legal Business Name | WAGNER DRUGS INC
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 11/05/2021
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Provider Practice Location Address
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Address Line | 744 HWY 270 E
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City | MT IDA
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State | AR
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Zip | 71957-0066
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Country | US
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Telephone | 870-867-3174
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Fax | 870-867-2033
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Provider Business Mailing Address
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Address Line | PO BOX 66
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City | MOUNT IDA
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State | AR
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Zip | 71957-0066
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Country | US
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Telephone | 870-867-3174
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Fax | 870-867-2033
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Authorized Official
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Title or Position | OWNER
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Name | LAURA WAGNER
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Credential |
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Telephone | 870-867-3174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | AR15934
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License Number State | AR
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