Individual
MARY A WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
1650 COWLES ST, FAIRBANKS, AK 99701-5925
(907) 458-5610
Mailing address
PO BOX 61112, FAIRBANKS, AK 99706-1112
(907) 458-5610
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
1041
AK
Other
Enumeration date
04/17/2007
Last updated
07/08/2007
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