Individual
CHARLES ALLLEN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1804 CONNECTICUT AVE, ELKHART, IN 46514-8367
(574) 218-2613
Mailing address
901 JOHNSON ST, ELKHART, IN 46514-3329
(574) 264-5996
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
67010074A
IN
Other
Enumeration date
08/18/2022
Last updated
08/22/2022
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