# WAGNER DRUGS INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wagner's Mount Ida Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215187455
- **Authorized official:** LAURA WAGNER (OWNER)
- **Authorized official phone:** (870) 867-2812

## Contact information

- **Practice address:** 744 HIGHWAY 270 E, MOUNT IDA, AR 71957-8003
- **Practice address phone:** (870) 867-3174
- **Practice address fax:** (870) 867-2033
- **Mailing address:** PO BOX 66, MOUNT IDA, AR 71957-0066
- **Mailing address phone:** (870) 867-3174

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | AR15934 | AR | Yes |

## Other

- **Enumeration date:** 09/24/2008
- **Last updated:** 06/01/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 168721407 | — | AR |
| 01 | — | 2159831 | PK | — |