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MS. BLAIR SUZANNE WAGEMANN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.D.

Contact information

Practice address
153 E MONTE PAINTER DR, FAYETTEVILLE, AR 72703-4002
(479) 444-2259
Mailing address
13240 N OLD WIRE RD, ROGERS, AR 72756-9885
(479) 451-0413
(479) 451-0413

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
007777
AR

Other

Enumeration date
05/11/2007
Last updated
07/08/2007
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