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General NPI Number Information
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NPI Number | 1891099339
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Entity Type | Individual
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Provider Name | JACQUELINE ESTELLE LETOURNEAU-WAGNER PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 12/25/2010
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Last Update Date | 12/25/2010
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Provider Practice Location Address
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Address Line | 26520 CACTUS AVE RIVERSIDE COUNTY REGIONAL MEDICAL CENTER
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City | MORENO VALLEY
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State | CA
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Zip | 92555-3927
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Country | US
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Telephone | 951-486-4470
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Fax | 951-486-4475
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Provider Business Mailing Address
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Address Line | 7900 LIMONITE AVE G168
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City | RIVERSIDE
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State | CA
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Zip | 92509-6125
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Country | US
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Telephone | 951-681-7290
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Fax | 951-381-1429
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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 | 51117
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License Number State | CA
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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 | 14824
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License Number State | NV
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