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NPI Code Detail

MEDICARE: JAMES WAGNER

MEDICARE: JAMES 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
11835P1200XPharmacotherapy Pharmacist5302024859MI

General Provider Information

NPI Number : 1902217037
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES WAGNER
Provider Business Mailing Address
First Line : 15055 HALL RD
Second Line :
City : UTICA
State : MI
Zip : 48315
Country : US
Telephone Number : 586-566-0420
Fax Number : 586-566-1465
Provider Business Practice Location Address
First Line : 15055 HALL RD
Second Line :
City : SHELBY TOWNSHIP
State : MI
Zip : 48315-6206
Country : US
Telephone Number : 586-566-0420
Fax Number : 586-566-4165
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2014
Last Update Date : 05/12/2014

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