Organization
WAGNER DRUGS INC
Active
Other names
Wagner's Mount Ida Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA WAGNER (OWNER)
(870) 867-3174
Entity
Organization
Contact information
Practice address
744 HWY 270 E, MT IDA, AR 71957-0066
(870) 867-3174
(870) 867-2033
Mailing address
PO BOX 66, MOUNT IDA, AR 71957-0066
(870) 867-3174
(870) 867-2033
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR15934
AR
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168721407
—
AR
01
—
1994894
PK
—
Enumeration date
07/30/2006
Last updated
11/05/2021
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