Individual
BRENDA WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
215 WHALLEY AVE, NEW HAVEN, CT 06511-3205
(203) 401-4661
Mailing address
215 WHALLEY AVE, NEW HAVEN, CT 06511-3205
(203) 401-4661
(203) 401-4666
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PCT.0011050
CT
Other
Enumeration date
05/01/2019
Last updated
05/01/2019
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