Individual
DR. JEREMY WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
2000 S DOUGLAS HWY, GILLETTE, WY 82718-5414
(307) 682-4517
Mailing address
PO BOX 667, MOORCROFT, WY 82721-0667
(307) 756-2750
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
3549
WY
Other
Enumeration date
07/17/2012
Last updated
07/17/2012
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