Individual
LAURA LYNN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
744 HWY 270 EAST, MOUNT IDA, AR 71957
(870) 867-3174
Mailing address
PO BOX 66, MOUNT IDA, AR 71957-0066
(870) 867-3174
(870) 867-2033
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
AR08356
AR
Other
Enumeration date
03/22/2019
Last updated
03/22/2019
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