Individual
DIANE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4963 JOHN R RD, TROY, MI 48085-3572
(248) 689-2157
(248) 740-5940
Mailing address
4963 JOHN R RD, TROY, MI 48085-3572
(248) 689-2157
(248) 740-5940
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
5302022570
MI
Other
Enumeration date
05/09/2014
Last updated
05/09/2014
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