Individual
JASON WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1316 CHARLESTON AVE, MATTOON, IL 61938-4016
(217) 258-2920
Mailing address
1316 CHARLESTON AVE, MATTOON, IL 61938-4016
(217) 258-2920
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051-289951
IL
Other
Enumeration date
11/24/2020
Last updated
11/24/2020
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