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NPI Code Detail

MEDICARE: RICHARD WAGNER RPH

MEDICARE: RICHARD WAGNER RPH
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
1183500000XPharmacistPH00013807WA

General Provider Information

NPI Number : 1366427924
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD WAGNER RPH
Provider Business Mailing Address
First Line : 526 228TH AVE NE
Second Line :
City : SAMMAMISH
State : WA
Zip : 98074-7226
Country : US
Telephone Number : 425-868-1112
Fax Number :
Provider Business Practice Location Address
First Line : 526 228TH AVE NE
Second Line :
City : SAMMAMISH
State : WA
Zip : 98074-7226
Country : US
Telephone Number : 425-868-1112
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2005
Last Update Date : 06/06/2008

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Directions to “ RICHARD WAGNER RPH” Practice Location

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