Provider Demographics
NPI:1578171054
Name:WAGGENER, JEANNE DUNCAN (RPH)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:DUNCAN
Last Name:WAGGENER
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 1:96 SUGAR CREEK PL
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3408
Mailing Address - Country:US
Mailing Address - Phone:254-744-7604
Mailing Address - Fax:
Practice Address - Street 1:96 SUGAR CREEK PL
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3408
Practice Address - Country:US
Practice Address - Phone:254-744-7604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist