Individual
STACEY WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3001 BROADWAY AVE, YANKTON, SD 57078-4890
(605) 665-8197
Mailing address
41083 258TH ST, MITCHELL, SD 57301-5848
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
R6534
SD
Other
Enumeration date
11/02/2020
Last updated
11/02/2020
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