Individual
MRS. ELIZABETH WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPH
Contact information
Practice address
1301 N SANTA FE AVE, EDMOND, OK 73003-3673
(405) 340-0522
Mailing address
4200 SHILOH LN, EDMOND, OK 73034-6904
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10611
OK
Other
Enumeration date
11/24/2017
Last updated
11/24/2017
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