Individual
LAURA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
402 COLLEGE AVE, CLEMSON, SC 29631-2923
(864) 654-1771
Mailing address
402 COLLEGE AVE, CLEMSON, SC 29631-2923
(864) 654-1771
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
009854
SC
Other
Enumeration date
04/02/2007
Last updated
07/08/2007
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