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General NPI Number Information
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NPI Number | 1881290765
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Entity Type | Individual
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Provider Name | ERIKA JANEMARIE WANNER
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Gender | Female
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Dates
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Enumeration Date | 12/07/2020
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Last Update Date | 12/07/2020
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Provider Practice Location Address
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Address Line | 900 N 6TH ST
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City | BLYTHEVILLE
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State | AR
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Zip | 72315-1702
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Country | US
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Telephone | 870-763-4507
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Fax | 870-762-0782
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Provider Business Mailing Address
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Address Line | 622 KOSER DR
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City | MARION
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State | AR
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Zip | 72364-2671
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Country | US
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Telephone | 859-552-7910
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PST.020993
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0000034124
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | E-010556
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | C14504
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License Number State | AR
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