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General NPI Number Information
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NPI Number | 1912580465
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Entity Type | Individual
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Provider Name | SETH ALLEN WAGNER PHARMD
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Gender | Male
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Dates
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Enumeration Date | 05/03/2021
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 1749 WOODSTONE DR
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City | SAINT PETERS
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State | MO
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Zip | 63376-7404
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Country | US
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Telephone | 636-447-1229
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 HIGHWAY K
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City | O FALLON
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State | MO
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Zip | 63368-6661
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Country | US
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Telephone | 636-379-1918
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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 | 051297649
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License Number State | IL
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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 | 2016007951
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License Number State | MO
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