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NPI Code Detail

MEDICARE: MRS. MERCEDES FAJARDO WAGNER PHARM.D.

MEDICARE:  MRS. MERCEDES FAJARDO WAGNER  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
1183500000XPharmacist42401CA

General Provider Information

NPI Number : 1831516509
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MERCEDES FAJARDO WAGNER PHARM.D.
Provider Business Mailing Address
First Line : 23631 DANE CT
Second Line :
City : LAGUNA NIGUEL
State : CA
Zip : 92677-4618
Country : US
Telephone Number : 949-249-9665
Fax Number : 949-149-9665
Provider Business Practice Location Address
First Line : 23631 DANE CT
Second Line :
City : LAGUNA NIGUEL
State : CA
Zip : 92677-4618
Country : US
Telephone Number : 949-249-9665
Fax Number : 949-249-9665
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2014
Last Update Date : 03/19/2014

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