Jesse Sue Wageman, PHARMD

NPI #1598050445 in Chubbuck, Idaho

Provider Information

NPI Number: 1598050445
Entity Type: Individual
Name: Jesse Sue Wageman, PHARMD
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Pharmacist
Credential: PHARMD
Enumeration Date: Jun 17, 2011
Last Updated: Nov 10, 2014

Practice Location

Address: 4845 YELLOWSTONE AVE
City: Chubbuck
State: Idaho
ZIP Code: 83202-2333
Phone: (208) 237-3900

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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