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NPI Code Detail

MEDICARE: DR. CHARLA LATANE WAGERS PHARM.D.

MEDICARE: DR. CHARLA LATANE WAGERS PHARM.D.
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
1183500000XPharmacist011808KY

General Provider Information

NPI Number : 1659351575
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLA LATANE WAGERS PHARM.D.
Provider Business Mailing Address
First Line : 1 TRILLIUM WAY
Second Line : BAPTIST REGIONAL MEDICAL CENTER PHARMACY
City : CORBIN
State : KY
Zip : 40701-8426
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1 TRILLIUM WAY
Second Line : BAPTIST REGIONAL MEDICAL CENTER PHARMACY
City : CORBIN
State : KY
Zip : 40701-8426
Country : US
Telephone Number : 606-523-8545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2006
Last Update Date : 07/18/2007

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