Individual
ALICEN WAGENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
844 W FREMONT ST, GALESBURG, IL 61401-2509
(309) 343-5141
(309) 343-6821
Mailing address
6025 170TH ST, BURLINGTON, IA 52601-9274
(319) 937-5855
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051-295368
IL
183500000X
Pharmacist
21549
IA
Other
Enumeration date
09/21/2011
Last updated
09/21/2011
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