Individual
MR. JOHN HERBERT WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R. PH.
Contact information
Practice address
3900 ERIE ST, RACINE, WI 53402-3544
(262) 639-1611
(262) 639-5611
Mailing address
3900 ERIE ST, RACINE, WI 53402-3544
(262) 639-1611
(262) 639-5611
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
8002-40
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225062441
NPI
WI
Enumeration date
03/30/2015
Last updated
03/30/2015
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