Individual
MR. DANIEL GORDON WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1350 LEE BLVD, LEHIGH ACRES, FL 33936-4846
(239) 369-2163
Mailing address
1350 LEE BLVD, LEHIGH ACRES, FL 33936-4846
(239) 369-2163
(239) 368-7497
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PS0027995
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105903300
—
FL
Enumeration date
11/25/2020
Last updated
11/25/2020
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