Individual
ANDREA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
4518 COTTAGE GROVE RD, MADISON, WI 53716-1206
(608) 222-3648
Mailing address
10210 RUSTLING BIRCH RD APT 311, VERONA, WI 53593-5141
(763) 331-5779
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
21339-40
WI
Other
Enumeration date
07/18/2022
Last updated
07/18/2022
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