Individual
DANIELLE WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
501 W LINCOLN AVE, CHARLESTON, IL 61920-2443
(217) 345-7069
Mailing address
29 FAIRWAY LN, MATTOON, IL 61938-9015
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051.289971
IL
Other
Enumeration date
11/22/2020
Last updated
11/22/2020
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