Individual
ELONA VAN WAGENEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
4800 MCMAHON BLVD NW, ALBUQUERQUE, NM 87114-5010
(505) 922-4303
(505) 922-4313
Mailing address
4800 MCMAHON BLVD NW, ALBUQUERQUE, NM 87114-5010
(505) 922-4303
(505) 922-4313
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP00007292
NM
Other
Enumeration date
09/21/2010
Last updated
09/21/2010
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