Provider Demographics
NPI:1164542452
Name:WAGGETT, JOHN DAVIE (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVIE
Last Name:WAGGETT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 BAYSHORE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9419
Mailing Address - Country:US
Mailing Address - Phone:910-686-1661
Mailing Address - Fax:910-686-1675
Practice Address - Street 1:2059 CAROLINA BEACH RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7239
Practice Address - Country:US
Practice Address - Phone:910-762-6278
Practice Address - Fax:910-343-0710
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7169183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7169OtherBOARD OF PHARMACY