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Organization
WAGNER DRUGS INC
Active
Organization
WAGNER DRUGS INC
Active
Other names
Wagner's Mount Ida Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA WAGNER (OWNER)
(870) 867-2812
Entity
Organization
Contact information
Practice address
744 HIGHWAY 270 E, MOUNT IDA, AR 71957-8003
(870) 867-3174
(870) 867-2033
Mailing address
PO BOX 66, MOUNT IDA, AR 71957-0066
(870) 867-3174
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
AR15934
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168721407
—
AR
01
—
2159831
PK
—
Enumeration date
09/24/2008
Last updated
06/01/2016
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