Individual
AUSTIN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
351 HOSPITAL RD STE 107, NEWPORT BEACH, CA 92663-3503
(949) 764-6580
Mailing address
24745 STEWART ST, LOMA LINDA, CA 92350-1719
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
85751
CA
Other
Enumeration date
12/22/2021
Last updated
12/22/2021
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