Individual
JASON C BAGLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1326 N COLISEUM BLVD, FORT WAYNE, IN 46805-5526
(260) 739-6069
(260) 739-6696
Mailing address
3126 S 550 W, SHELBYVILLE, IN 46176-9030
(317) 642-8174
(260) 739-6696
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26018380A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26018380A
PHARMACIST STATE LICENSE
IN
Enumeration date
11/10/2016
Last updated
11/10/2016
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