Wagner Pharmacy

NPI #1356356927 in Aledo, Illinois

Provider Information

NPI Number: 1356356927
Entity Type: Organization
Organization Name: Wagner Pharmacy
Primary Specialty: Pharmacist
Enumeration Date: Jul 30, 2006
Last Updated: Apr 20, 2008

Practice Location

Address: 108 N COLLEGE AVE
City: Aledo
State: Illinois
ZIP Code: 61231-1519
Phone: (309) 582-5678

Authorized Official

Name: GARY R WAGNER, RPH
Title: PHARMACIST
Phone: (309) 582-5678

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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