Individual
BRIAN EDWIN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD.
Contact information
Practice address
1616 BLACK RIVER BLVD N, ROME, NY 13440-3609
(315) 339-5290
Mailing address
157 BEN BAR CIR, WHITESBORO, NY 13492-3023
(716) 725-1374
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
20 051145
NY
Other
Enumeration date
11/08/2007
Last updated
04/26/2011
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