Provider Demographics
NPI:1134658792
Name:WANGLIE, JOANN MEREDITH
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:MEREDITH
Last Name:WANGLIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1568 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067-7073
Mailing Address - Country:US
Mailing Address - Phone:334-285-0322
Mailing Address - Fax:
Practice Address - Street 1:145 KELLEY BLVD
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:AL
Practice Address - Zip Code:36054-2200
Practice Address - Country:US
Practice Address - Phone:334-285-0322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist