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General NPI Number Information
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NPI Number | 1619326881
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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 | 06/08/2016
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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 EAST
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City | MOUNT IDA
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State | AR
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Zip | 71957
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Country | US
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Telephone | 870-867-2812
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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 | 479-243-6169
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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 LYNN WAGNER
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Credential |
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Telephone | 870-867-2812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | AR15934
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License Number State | AR
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