Individual
DR. KEITH ALOYSIUS WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
950 15TH ST RM 1C-104C, AUGUSTA, GA 30901-2608
(706) 733-0188
Mailing address
807 WINDSOR CT, AUGUSTA, GA 30909-3477
(706) 833-4526
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
33877
TX
Other
Enumeration date
10/22/2018
Last updated
10/22/2018
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