Provider Demographics
NPI:1417675133
Name:WAGERS, KATHERINE F O (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:F O
Last Name:WAGERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:F O
Other - Last Name:WAGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:194 LOOPER BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:TN
Mailing Address - Zip Code:38574-5610
Mailing Address - Country:US
Mailing Address - Phone:423-429-1458
Mailing Address - Fax:
Practice Address - Street 1:346 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-3407
Practice Address - Country:US
Practice Address - Phone:931-879-8133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46670183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist