Organization
WAGNERS PHARMACY INC
Active
Organization
WAGNERS PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PATRICIA M WAGNER (OWNER)
(502) 426-1788
Entity
Organization
Contact information
Practice address
3113 S 4TH ST, LOUISVILLE, KY 40214
(502) 375-3800
(502) 375-0085
Mailing address
3113 S. 4TH ST, LOUISVILLE, KY 40214
(502) 375-3800
(502) 375-0085
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
P00851
KY
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54004643
—
KY
Enumeration date
01/30/2007
Last updated
08/27/2012
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