Justin Wagner
NPI #1245647700 in Gallup, New Mexico
Provider Information
- NPI Number
- 1245647700
- Entity Type
- Individual
- Name
- Justin Wagner
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Pharmacist
- Enumeration Date
- Jul 16, 2014
- Last Updated
- Jul 16, 2014
Practice Location
- Address
- 1650 W MALONEY AVE
- City
- Gallup
- State
- New Mexico
- ZIP Code
- 87301-3305
- Phone
- (505) 722-3823
Specialties & Taxonomy Codes
| Specialty |
|---|
| Pharmacist |
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