Individual
DR. JAMIE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
051296931
IL
1835P1200X
Pharmacotherapy Pharmacist
5302041340
MI
1835P1200X
Pharmacotherapy Pharmacist
Primary
T14003
MS
Other
Enumeration date
05/13/2020
Last updated
05/13/2020
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