Individual
DENNIS H WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPH
Contact information
Practice address
2703 N ROCKWELL AVE, BETHANY, OK 73008-5246
(405) 789-6881
(405) 787-9793
Mailing address
2703 N ROCKWELL AVE, BETHANY, OK 73008-5246
(405) 789-6881
(405) 787-9793
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
1-4168
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-4168
STATE LICENSE
OK
Enumeration date
10/17/2006
Last updated
07/08/2007
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