Individual
HEATHER WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3644 W STATE HIGHWAY 18, MANILA, AR 72442-8049
(870) 561-1500
Mailing address
PO BOX 910, MANILA, AR 72442-0910
(870) 243-1442
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PD10357
AR
Other
Enumeration date
08/18/2025
Last updated
08/18/2025
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