Provider Demographics
NPI:1407144801
Name:VAGNER, ANNA B (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:B
Last Name:VAGNER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HILLTOP CIR
Mailing Address - Street 2:
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1404
Mailing Address - Country:US
Mailing Address - Phone:908-436-7711
Mailing Address - Fax:732-345-1635
Practice Address - Street 1:100 RTE 9 STE 10
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3017
Practice Address - Country:US
Practice Address - Phone:732-308-9099
Practice Address - Fax:732-308-9007
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02527900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist