MEDICARE: ALAN WAGNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03236736	OH

General Provider Information

NPI Number	:	1104372416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN WAGNER

Provider Business Mailing Address
First Line	:	1391 CONANT ST
Second Line	:
City	:	MAUMEE
State	:	OH
Zip	:	43537-1609
Country	:	US
Telephone Number	:	419-891-8710
Fax Number	:

Provider Business Practice Location Address
First Line	:	1391 CONANT ST
Second Line	:
City	:	MAUMEE
State	:	OH
Zip	:	43537-1609
Country	:	US
Telephone Number	:	419-891-8710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2016
Last Update Date	:	03/26/2026

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Directions to “ ALAN WAGNER ” Practice Location

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