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General NPI Number Information
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NPI Number | 1881731073
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Entity Type | Organization
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Legal Business Name | WAGNERS PHARMACY INC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/27/2012
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Provider Practice Location Address
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Address Line | 3113 S 4TH ST
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City | LOUISVILLE
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State | KY
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Zip | 40214
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Country | US
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Telephone | 502-375-3800
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Fax | 502-375-0085
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Provider Business Mailing Address
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Address Line | 3113 S. 4TH ST
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City | LOUISVILLE
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State | KY
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Zip | 40214
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Country | US
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Telephone | 502-375-3800
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Fax | 502-375-0085
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Authorized Official
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Title or Position | OWNER
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Name | MS. PATRICIA M WAGNER
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Credential |
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Telephone | 502-426-1788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P00851
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License Number State | KY
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