Individual
ERICA L WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 OVERLOOK TER, MADISON, WI 53705-2254
(608) 256-1901
Mailing address
2127 E BROADWAY UNIT A, WAUKESHA, WI 53186-8159
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
17183-40
WI
Other
Enumeration date
07/31/2013
Last updated
07/31/2013
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