Provider Demographics
NPI:1225150873
Name:WAGNER, SHERYL M (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:M
Last Name:WAGNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 BANK ST
Mailing Address - Street 2:APT 2
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-2318
Mailing Address - Country:US
Mailing Address - Phone:410-467-6040
Mailing Address - Fax:410-467-2448
Practice Address - Street 1:3013 GREENMOUNT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3939
Practice Address - Country:US
Practice Address - Phone:443-872-7794
Practice Address - Fax:410-467-6040
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist